Centene Corporation
Description
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.
Roles and Responsibilities
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.
