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.
 

Position Purpose: The position will support the Medicaid and CHIP in the following capacity:

• The role will include overview of the quality product performance which may include analysis of the existing performance and planning for future change in legislation/policy. The product is provided certain benchmarks by the state agency, which at times may require clinical initiatives to be implemented to ensure successful performance.
• The analysis of quality and product data will include ongoing interdepartmental conversations with the coordination team to help ensure that we continue on track and ensure execution of projects or clinical initiatives.
• The role will include engagement with internal stakeholders to review clinical outcomes based on reported data from the state agency including internal data reporting.
• The role will participate during the product Utilization Review, which usually occurs on a yearly basis, and includes clinical chart audits, mitigation strategies implementation and engagement with the state agency based on final reporting, as appropriate.
• Serves as the subject matter expert (SME) for the assigned product(s) or service area(s).
• Drives assigned operational aspects of the product(s)/service(s).
• Assesses operational performance and escalations by tracking, analyzing and researching performance level expectations.
• Monitors assigned internal/external relationships to ensure compliance with contractual requirements.
• Develops effective relationships with key partners and stakeholders to influence and drive operational enhancements.
• Proactively identifies trends and root cause analysis to drive resolution of complex escalations; including communications and reporting.
• Creates reports and supports business review presentations to key stakeholders; including, but not limited to, Senior Leadership Team, Vendors and/or Government agencies.
• Participates in and supports department and/or product strategic planning activities.
• Manages projects including the implementations for delegated functions as needed.
• Collaborates with internal and/or external partners to execute assigned business objectives and initiatives.
• Ensures member or other stakeholder communications contain appropriate information, talking points and FAQs, and are effectively implemented.
• Performs other duties as assigned.

- Quality Performance Oversight:
- Quality Initiative Development and Tracking:
- Product Quality Support: The role will include overview of the quality product performance which may include analysis of the existing performance and planning for future change in legislation/policy. The product is provided certain benchmarks by the state agency, which at times may require clinical initiatives to be implemented to ensure successful performance.

Education/Experience: Associate's degree in Nursing, or within Health Care with 3 years preferred in Managed Care and Quality experience. Experience with data analytics and reporting.

License/Certificates: Required, RN, NP, LPC, LSW, ST, PT, or OT

Travel: At minimum 10%, for team meetings.

Pay Range: $68,700.00 - $123,700.00 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