Program Manager II-Recovery Operations/Payment Integrity

Position Purpose: Plan, organizes, monitor, and oversee programs utilizing cross functional teams to deliver defined requirements and meet business needs and strategic objectives.

• Serve as the primary coordinator for Recovery Operations and Recovery Platform initiatives by organizing work across operational, business, and technology teams, facilitating meetings with internal stakeholders and external partners, managing issue resolution, and ensuring timely delivery of strategic priorities.
• Monitor recovery inventory, operational performance, and platform-related initiatives; identify risks and bottlenecks, coordinate remediation efforts with BTS and business teams, and provide executive-level reporting on program status, issues, and key performance metrics.
• Support business department initiatives that promote, quality, safety and cost of care opportunity.
• Responsible for gathering requirements, creating plans and schedules, managing resources, and facilitate project execution and deployment.
• Utilize corporate and industry standard tools and techniques to effectively oversee programs according to department procedures.
• Maintain detailed business process documentation including meeting minutes, action items, issues lists and risk management plans as applicable.
• Create and monitor all department deliverables to ensure adherence to quality standards including clinical reporting documents, related reference materials, and policy and procedure documentation.
• Communicate program status to management and key stakeholders.
• Identify resources, resolve issues, and mitigate risks.
• Identify requirements, procedures and problems to improve existing processes.
• Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and business objectives.
• Manage projects through the full project life cycle.
• Provide leadership and effectively communicate project status to all stakeholders.
• Negotiate with project stakeholders to identify and secure resources, resolve issues and mitigate risks.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience: Bachelor's Degree in related field or equivalent experience required. 3+ years of quality improvement, program management or project management experience required. Health care experience preferred.

Preferred experience supporting healthcare recovery operations, payment integrity, claims operations, revenue cycle, or related healthcare business functions. Preferred knowledge of recovery inventory management, operational reporting, workflow optimization, and process improvement methodologies.  Preferred experience partnering with business stakeholders, technology teams (BTS/IT), and external vendors to deliver system enhancements and operational initiatives with JIRA, ServiceNow, etc.  Preferred familiarity with claims processing systems, recovery platforms, workflow management tools, data analytics, and performance reporting.  Preferred experience leading cross-functional projects involving technology implementations, system integrations, or operational transformation initiatives. Preferred lean Six Sigma Green Belt, Agile, Scrum, SAFe, or other process improvement/project management certification preferred.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act