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Senior Trainer and Auditor (Clinical)

Superior HealthPlan El Paso, Texas, Texas

As a member of the Centene Medical Management/Health Services team, you’ll help innovate and execute strategies that redefine the industry standard for improving the lives and health of people. We’re 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, we’re transforming the health of communities, one person at a time.

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What does it take?

What are the qualities that will help you achieve success in this role at Centene?

Success Profile

  • Detail-oriented
  • Trustworthy
  • Personable
  • Quick-thinking
  • Multi-tasker
  • Good listener

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Our Medical Roles

Clinical & Nursing Opportunities at Centene

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, you’ll assess acute member health conditions, treatment and intervention options, and match them with providers, community and health plan resources.

Prior Authorization Nurse

You’ll 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, you’ll 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, you’ll identify individual member health risks and opportunities to enhance independence, quality of life and community engagement.

Referral Specialist

You’ll 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, you’ll review population health data, help design clinical programs, and develop care delivery partnerships.

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Responsibilities

Job ID 1165771
Additional Locations Texas,Texas,US;Texas,Texas,US;Texas,Texas,US;Texas,Texas,US
Category Clinical & Nursing
Schedule Full-time
Description:
Position Purpose: The Senior Trainer and Auditor will develop, conduct, administer and analyze clinical training programs, conduct audits of clinical systems entry and/or processes, and assist in development of audit tools.  Position will cover El Paso, San Antonio, McAllen, Dallas and Austin and will travel up to 40% of the time.

  • Develop and conduct clinical education courses, including case management education and training for new employees
  • Develop and maintain complex audit processes and audit tools related to authorizations, appeals, quality, case management, inter-rater reliability and data entry
  • Audit established guidelines (e.g. Interqual) for medical necessity
  • Analyze training needs and identify, select or develop appropriate training programs including training aids and materials
  • Audit staff in accordance with established auditing processes, work with staff to identify and resolve errors in data and reporting, and present findings and recommendations for improvement to management
  • Train audit staff in the use of audit tools and identification of patterns or trends that require additional training or corrective action
  • Evaluate effectiveness of training programs including cost/benefit analyses
  • Research, analyze, and recommend internal/external training programs
  • Maintain records of training activities and employee progress
  • Assist with revisions to Policy and Procedure and/or work process development
  • Participate in Quality and Advisory committees) or provider education meetings
  • Travel up to 40% within assigned territory
  • Qualifications:

    Education/Experience: Bachelor’s degree in Nursing, related clinical field or equivalent experience. 4+ years of experience in nursing, training, or auditing in a 
    healthcare setting - managed care experience preferred. Strong training background and experience in a lead or supervisory role preferred. Texas Medicaid, STAR kids, STAR health and STAR plus experience and knowledge a plus.

    License/Certification: 
    Current state RN nursing license. Valid driver’s license required.

    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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    Quote

    “Centene is an exciting company to work for, the pace at which we’re 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.”

    - Julie Boulch, Director, Business Implementation Health Plan Initiatives

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    Our Awards

    Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.

    Honored to be Honored

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    Our Hiring Process

    Learn more about our hiring process and discover other helpful information for applicants.

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    “Flexibility is key. Centene is a company of change.”

    Ashley Collier

    Started as a Referral Specialist, now a Project Manager IV

    See Ashley's career path

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