Clinician Specialist (RN)
LA Healthcare Connections Lafayette, Louisiana
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.
What does it take?
What are the qualities that will help you achieve success in this role at Centene?
- Good listener
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.
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.
You’ll use our data systems to directly assist providers, requesting services and treatments for our members.
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.
Category Clinical & Nursing
Position Purpose: The Clinician Specialist provides clinical and operational support, guidance, and direction to the department related to utilization management and/or case management. The position is responsible to develop, implement, and monitor clinical documentation incorporated into clinical guidelines, policies, and/or procedures that will enable the department to meet and exceed goals, maintain regulatory compliance, improve quality, and promote overall efficiency and effectiveness related to clinical practices.
Under the direction of departmental leadership and the Medical Directors, draft clinical guidelines in a standardized format to be utilized by department staff that align with departmental policies and procedures. This may including drafting (and/or creating new entries in the information system) new clinical criteria, as well as reviewing existing criteria for opportunities to modify and edit criteria as needed to ensure guidelines are up to date, and in compliance with state and federal guidelines.
Monitor and organize the clinical-focused Department Standard Operating Procedure (SOP) and Policy & Procedures to ensure accuracy, creates new standard operating procedures as needed to facilitate compliance with state and federal regulations. Collaborates with Department leadership and Medical Directors to assist in development or modification of policies & procedures as needed.
Oversee the modification or creation of member and provider letters, including determination notices and other regulatory notices, utilized by the department. Suggests and implements modifications as necessary to ensure regulatory compliance as well as improved efficiency. Collaborates with internal stakeholders to ensure impacted staff are educated on new policies, procedures, and processes to ensure successful implementation and compliance.
Measure and evaluate effectiveness as it relates to current workflows and processes; compare measurement results to standards and work with the team to improve performance and close identified gaps.
Research and identify industry best practices and other relevant available published information to contribute to the development of guidelines, policies, and procedures in order to achieve optimal clinical and/or operational outcomes. Develop and maintain documentation necessary to support consistent, operationally sound processes such as tip sheets, standard operating procedures, audit tools.
Obtain data and/or run basic reports to determine department performance related to areas of focus, as directed by department leadership. Summarize data for casual analysis or create basic presentations order to communicate progress to management.
Job performance requires fulfilling other incidental or related duties as assigned, including but not limited to collaborating with department trainer and supervisory staff in order to plan for implementations and roll out new policies and/or procedures, reviewing regulatory updates, and participating in a variety of department projects.
Education/Experience: MA/MS – Masters Degree preferred. 3-5 years related experience required. For Clinical Specialist position in Medical Management: Experience with MCG clinical guidelines required. Prior experience with MCG CareWeb QI guideline modification module preferred.Case Management/Utilization Management highly preferred.
License/Certification: RN 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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“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
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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“Flexibility is key. Centene is a company of change.”
Started as a Referral Specialist, now a Project Manager IVSee Ashley's career path
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