You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Must live in Indiana
Indiana (MHS) Medicaid experience preferred
Clinical RN Highly preferred
Understanding clinical pathway
Experience with Indiana Medicaid, NCQA, CMS, UM appeals/grievances, delegated/vendor oversight, or health plan audit readiness is preferred
Position Purpose:
- Responsible for managing and tracking clinical projects that advance the objectives of strategic plan with key provider groups and/or hospital systems by supporting established committees and creating new work teams; including such activities as organizing and publishing agendas, documenting minutes, maintaining work plans and monitoring open action items
- Works closely with the Regional Medical Director to analyze data and develop and implement key interventions to support the Triple Aim, including developing work plans, workflows, policies and procedures, and serving as workgroup leader when appropriate in order to execute initiatives.
- Serves as project leader for cross functional initiatives that are intended to drive performance improvement engaging across functional teams as needed to ensure effective communication of project requirements, as well as tracks progress of action plans.
- Facilitates the development of clinical reports and the delivery of data to key provider partners; as well as develops internal reports to demonstrate progress.
- Performs detailed analysis of data, workflows, policies, procedures and organization of staff, in order to execute initiatives.
- May use project management software to support initiatives.
- Performs other duties as assigned
- Complies with all policies and standards
Must live in Indiana
Indiana (MHS) Medicaid experience preferred
Clinical RN Highly preferred
Understanding clinical pathway
Experience with Indiana Medicaid, NCQA, CMS, UM appeals/grievances, delegated/vendor oversight, or health plan audit readiness is preferred
The Clinical Program Manager is responsible for identifying, managing and tracking clinical, quality, correct coding, documentation and data submission projects that advance the objectives of the Health Plan's strategic goals. The Clinical Program Manager facilitates the development of internal and external reports and the delivery of data as needed to support and monitor the action plans to accomplish the Triple Aim: 1) to improve member experience, 2) improve the quality of care and 3) to reduce health care costs.
Education/Experience: Bachelor’s Degree in Nursing, International Medical Graduate, Master’s Degree in Public Health (MPH), Hospital Administration (MHA) or Business Administration (MBA) or equivalent experience . Five to seven years managed care, hospital or medical group experience, focusing on quality improvement, utilization management, or clinical operations. Experience analyzing and presenting data to drive outcomes. Experience making presentations in group settings. At least two years project management experience of managing a project at any level at a medical group, IPA or health plan setting.
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
