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Form of workYou 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: Serve as a liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams.
- Interpret and present program results and develop data-driven analysis and metrics used to measure effectiveness and ROI of all current and new programs
- Partner with various staff, along with internal and external departments on provider education and outreach; determine where there are gaps and work to develop and deploy education efforts
- Partner with regional leadership for providers requiring a clinical interpretation of results related to health plan reporting, data and quality incentive payments; facilitate discussions to make recommendations
- Implement and manage procedures for tracking, identifying and problem-solving operational issues, including issues between the provider network, community, and the facility, and make recommendations to solve
- Act as the clinical representative in various meetings
- Collaborate with staff to identify internal and external opportunities and initiate process changes to increase quality and improve staff, provider and member satisfaction
- Serve as resource and liaison on utilization, quality improvement and case management activities
Education/Experience: Master's in Social Work / Behavioral health. 5+ years of experience in managed care, utilization management, case management, or quality improvement
License/Certification: LPC, LCSW
For Behavioral Health: LPC, LCSW, LHMC, LMFT
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
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.
