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.
 

The ideal candidate will possess experience in healthcare claims, clinical program management, operational data analysis within managed care or value-based care settings, data analytics, clinical program development, proficiency in programming languages including BI tools, expertise in data visualization, and a background in creating SQL queries.

This position offers remote work flexibility, enabling candidates to be based anywhere in the United States.

Position Purpose: This position will play a significant role in improving clinical program, quality performance, provider satisfaction, and member experience, and operational performance, including access to care. Lead and direct process improvement initiatives by utilizing process improvement methodologies in the analysis of current operations and design of clinical operations. Manage activities related to re-procurement process, provider engagement, clinical program data support, and regulatory requirements. This role may be focused on a specific line of business (Medicaid, Medicare, Marketplace/Commercial) to ensure enterprise population health programs goals are aligned with the business goals. Facilitates and manages the adoption and scaling of enterprise population health programs ensure successful implementation and adoption to meet the line of business needs. Continuously reevaluating programs to ensure they meet changing regulatory requirements and member population for their assigned line of business.

• Partner with clinical programs team to inform program design, evaluation, and optimization using data
• Manage relationships with hospitals, providers, clinics, and delegated groups as well as manage relationships with information technology, clinical leadership, clinicians, Health Plans and specific lines of business.
• Ensure that all external activities are coordinated to enhance provider experience and member experience to maximize efficiency.
• Gather, analyze, track and present data on key performance indicators.
• Develop, implement, and manage external facing projects and programs aimed at improvements in cost, quality, and service.
• Track progress of projects and implementation of action plans.
• Prepare and present periodic reports on provider/program performance.
• Co-lead the development and implementation of process improvement initiatives with cross-functional teams.
• Co-manage projects and programs aimed at improvements in cost, quality, and services.
• Ensure all efforts align and support vision and strategic plan.
• Manage activities related to re-procurement, compliance with contractual/regulatory requirements, and meeting or exceeding key performance indicators (RAF, STARS, HEDIS, MCAS, etc.).
• Manages program to improve clinical quality performance, provider satisfaction, and member experience, and operational performance, including access to care.
• Performs other duties as assigned
• Complies with all policies and standards

The ideal candidate will possess experience in healthcare claims, clinical program management, operational data analysis within managed care or value-based care settings, data analytics, clinical program development, proficiency in programming languages including BI tools, expertise in data visualization, and a background in creating SQL queries.

This position offers remote work flexibility, enabling candidates to be based anywhere in the United States.

Education/Experience:

• Master's Degree in Healthcare Administration, Nursing, Public Health, Business Administration, Healthcare Policy, or equivalent field or equivalent experience required:
• 5+ years experience in managed care required
• Strong knowledge of operational, regulatory, clinical, and reporting requirements for Managed Care Plans (MCP) operating in multiple lines of business
• Experience leading the implementation of programs in managed care and co-leading cross-functional teams
• Experience in clinical programs development, informatics, data interpretation and analysis
• Clinical license (e.g., RN, LCSW, LCPC, LICSW, Ph.D. or Psy.D., PMHNP, CNS, LMHC) preferred

Pay Range: $86,000.00 - $154,700.00 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.  Total compensation may also include additional forms of incentives.

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