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Manager, Medical Management (Training & Auditing)

Charlotte, North Carolina Apply Now Job ID 1145118 Category Health Insurance Operations Organization Carolina Complete Health Schedule Full-time
Position Purpose: Ensure medical management policies and procedures are compliant and consistent with the integrated care requirements. Manage the planning/development and coordination of all medical management auditing activities. Through routine and special case audits, identify educational, training and auditing needs for the assigned business unit(s). Provide support to Medical Management to determine root causes of operational process inefficiencies, process improvement opportunities and facilitate the creation of action plans for resolution.

Evaluate and resolve inefficiencies to identify and drive process improvement opportunities.
Utilize continuous process improvement techniques to explore approaches to work processes to eliminate waste and ensure resources are allocated to high value activity.
Adopt and modify state specific requirements to ensure compliance with state contractual requirements.
Assist with initiatives to bring greater effectiveness and efficiency.
Manage and participate in the training and development of auditing programs and tools.
Develop and manage the auditing inter-rater reliability process between health plan and corporate auditing functions.
Ensure audit process is in compliance with latest NCQA, State or Federal requirements.
Manage the auditing department and staff.
Manage content of policies and procedures to ensure content is current and audit-ready
Lead, facilitate and participate in multi-department/cross-functional committees and work groups which support key initiatives.

Education/Experience: Bachelor’s degree in Healthcare Administration, Nursing, Public Health, or related field or equivalent experience. 4+ years of managed are experience required. 0-3 years of supervisory/management experience.

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.
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