Program Manager III – SIU Intelligence, Innovation

🔥 20 hours ago

🗽 New York – Remote

🗽 New York – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Program Manager

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Support strategic planning, development, and execution of SIU proactive anti-fraud detection, tools, analytics programs, initiatives, and priorities • Transform large and complex data sets into defensible, actionable analytical insights for investigative lead generation, case development, fraud prevention, and data-driven decision-making • Leverage HCFS PostShield, AI Shield, Pharmacy Shield, and other internal and external data assets to identify emerging risks and develop detection strategies • Partner with SIU leadership and enterprise stakeholders to design and implement analytical methodologies, predictive monitoring solutions, dashboards, performance metrics, and reporting capabilities • Collaborate across SIU, Claims, Configuration, IT, Clinical, Compliance, Market Operations, and external partners • Research, evaluate, and monitor emerging fraud schemes, industry trends, regulatory developments, and analytical opportunities • Communicate analytical findings, fraud trends, program performance, financial impact, risks, and strategic recommendations to senior leadership and stakeholders • Maintain audit-ready documentation, including program roadmaps, governance artifacts, risk and decision logs, methodology documentation, claim volume analyses, performance metrics, and financial impact reporting • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Bachelor's Degree in Business Administration, Healthcare Administration, or related field, or four (4) years of equivalent experience required • 5+ years of program, project, or product management experience required • Experience related to healthcare fraud, analytics, investigations, project management, data science, or other related healthcare environments preferred • Preferred credentials: CFE, AHFI, CHC, PMP, SAS, CPC • Compliance with enterprise governance standards, regulatory requirements, policies, and standards • Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity