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As a member of the Centene Medical Management/Health Services team, youll help innovate and execute strategies that redefine the industry standard for improving the lives and health of people. Were a team of skilled physicians, nurses, pharmacists, social workers and health service experts who use our advanced clinical analytics to implement award winning programs, develop care, deliver partnerships, and work directly with our members to achieve outcomes that set us apart as industry leaders. Together, were transforming the health of communities, one person at a time. Centene is an exciting company to work for, the pace at which were growing allows numerous advancement opportunities. Also, we foster an environment that supports and offers numerous leadership growth opportunities. - Esmeralda Baig, SVP Operations, Complex Care Products I assisted with one of the Provider fairs in the community. Seeing how much we care for our community and our patients was very eye opening. Position Purpose: Lead and direct process improvement activities that provide more efficient and streamlined workflow. Responsible for leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance Responsible for quality improvement aspects of risk adjustment processes for all products Collaborate with Medicare STARS team to improve overall STARS ratings for Medicare products (including HEDIS, CAHPS, HOS) Oversee provider satisfaction surveys and implement action plans for improvements Research and incorporate best practices into operations Organize and control activities, methods, and procedures to achieve business objectives Review and implement new technological tools and processes and fosters team concept with internal and external constituencies Present results of improvement efforts and ongoing performance measures to senior management Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines Qualifications: Bachelor's degree in Nursing, related clinical degree or equivalent experience. 5-7 years of quality management, quality improvement experience in a large healthcare corporation serving Medicaid beneficiaries. License/Certificates: Current states RN license or LCSW required. Certified Professional in Health Care Quality preferred. Masters degree preferred. Our Clinical team is at the forefront of our purpose-driven work. Learn more about how you can help transform the health of our communities, one person at a time. Overall Medical Management A member of the Centene Medical Management team, we innovate and execute strategies that redefine the industry standard for improving the lives and health of people. Concurrent Review Nurse To ensure our members get the best quality of care, youll assess acute member health conditions, treatment and intervention options, and match them with providers, community and health plan resources. Prior Authorization Nurse Youll ensure our members get the best quality services, assistive devices, and equipment to promote optimal health and independence in the community and help promote health and independence. Care Manager Working directly with members, interdisciplinary care team, providers and data analytics, youll identify member health risks and conditions and intervention and service options. LTSS Program Specialist/Program Specialist Field Based Working directly with our most vulnerable members, youll identify individual member health risks and opportunities to enhance independence, quality of life and community engagement. Referral Specialist Youll use our data systems to directly assist providers, requesting services and treatments for our members. Medical Director To help support the individual needs of members and develop programs that address issues, youll review population health data, help design clinical programs, and develop care delivery partnerships. Centene is consistently recognized for how well we treat our members, our people, and the communities we serve. Search for a category, location, or category/location pair, select from the suggestions and click Add. Our local approach allows us to help members access high-quality, culturally sensitive healthcare services.
Associated topics: ambulatory, cardiothoracic, infusion, maternal, mhb, nurse, registered nurse, surgical, transitional, unit

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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