You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

This is a fully remote position and can be located anywhere in the US.

Position Purpose: Leads development and redesign of health plan clinical programs and operations through collaboration with leaders and external partners to optimize quality based clinical outcomes, utilization management metrics and meet state and Federal requirements for target populations and related programs. This individual operates within the medical management structure as a liaison to the Population Health Solutions organization for alignment of program goals and reporting on clinical and financial outcomes. This role builds consensus on program designs; facilitates feedback on clinical performance; and participates in on-going quality improvement processes.

• Collaborates with Medicare clinical CM and UM teams to lead clinical program development initiatives to support new business and re-procurement efforts.

• Develops clinical programs that are reflective of industry best practices and achieve market leading results in improving outcomes and reducing costs, while meeting the specific state and Federal program requirements.

• Delivers reports to internal stakeholders for evaluation, feedback and influence on program development or change.

• Through population health management strategic approaches develops and monitors deployment and performance of clinical programs (i.e. , complex care program, critical gaps in Care programs, etc.)

• Leads initiative based business and clinical program owners in assessment of program performance and improvement strategies.

• Evaluates program design and deployment plans for adherence to regulatory or contractual requirements.

• Maintains knowledge of competitive activity and program designs.

• Communicates to accreditation and delegation stakeholders program design, implementation status and performance metrics, as well as, quality improvement project details.

• Works with Medical Directors and network leadership to establish healthy provider relationships and communication channels.

• Provides an external voice within key industry groups on integrative health programs.

• Perform other duties as assigned.

Education/Experience:
Required A Bachelor's Degree in a related field:
Preferred A Master's Degree in a related field MPH, MBA, PhD, or MD:
Candidate Experience: Required 5+ years of management experience Healthcare or managed care settings
Required 5+ years of experience in Clinical program design and/or implementation and/or accreditation or quality management oversight
Required 5+ years of experience in Knowledge of Medicare and Medicaid benefit designs
Required 5+ years of experience in Business plan development, written and verbal presentations

 

Pay Range: $145,100.00 - $268,800.00 per year

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