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.
 

Candidates MUST live in California.

Position Purpose: Manages the development and implementation of clinical initiatives and/or programs to improve care coordination, efficiency, and health and quality outcomes. Manages the clinical operations team to ensure all clinical processes are consistent with National Committee for Quality Assurance (NCQA) guidelines, state mandates, and/or government contract requirements.

• Manages and oversees the development and review of clinical initiatives and/or programs to improve care coordination, efficiency, and health and quality outcomes
• Manages clinical, quality, documentation and data submission projects to achieve strategic objectives
• Reviews data analyses related to utilization, outcomes, safety, and costs to determine trends and identify areas of improvement for clinical initiatives and/or programs
• Develops, implements, and oversees clinical plans, policies, and procedures needed for strategic initiatives, programs, and improve processes and/or health and quality outcomes based on collected data
• Provides guidance and insight based on experience to clinical operations team on clinical processes and initiatives to improve care coordination, efficiency, and health and quality outcomes
• Sets goals and objectives for clinical operations team to improve care coordination, efficiency, and health and quality outcomes
• Reviews and refines reporting for senior leadership team on data needed to support and monitor initiatives and/or programs, and provides recommendations to improve member experience, improve the quality of care, and reduce health care costs
• Works with senior leadership team to ensure clinical initiatives and/or programs are in accordance with National Committee for Quality Assurance (NCQA) guidelines, state mandates, and/or government contract requirements
• Provides feedback to clinical operations leadership team to improve clinical initiatives and/or programs to improve processes and clinical coordination, efficiency, and health and quality outcomes
• Manages onboarding, hiring, and training clinical operations team members
• Works cross functionally to drive process improvements to manage costs and support initiatives to improve health and quality outcomes
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Requires a Bachelor's degree and 5+ years of related experience.

Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

License/Certification:
For Health Net of California: RN license required

Pay Range: $98,900.00 - $183,100.00 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