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.
This is a remote/work-from-home position. Candidates must reside within the state of California to be considered for this role.
Position Purpose: In conjunction with the Chief Medical Officer (CMO) and VP Clinical Programs, manage the implementation and administration of Clinical Program research and development. Oversee integration of internal operations needed to ensure compliance with clinical programs developed that are required under state contract, RFP, HEDIS, or other national standards.
- Work with CMO and VP, Clinical Programs with new programs designs.
- Research and facilitate implementation of new clinical programs for Centene Health Plans and/or specialty companies to meet State contract, RFP, HEDIS, or other organizational needs.
- Coordinate cross-functional meetings with various areas to meet overall stakeholder expectations and company’s objectives for clinical programs.
- Coordinate and/or create policies, procedures, workflow, training materials, and reporting in accordance with corporate, state and federal, HEDIS or other requirements.
- Manage the research and implementation functions for Clinical Programs to ensure program integrity and compliance.
- Oversee the integrity of Clinical Programs developed including outcome reporting and the publications.
- Coordinate with Corporate departments and Health Plans to execute Clinical Programs.
- Examine and evaluate Clinical Program goals, measures, and outcomes against demographic, historical and geographic membership and/or provider data.
- Facilitate ongoing reporting needs to reflect clinical program outcomes.
- Serve as an interface between the corporate program unit and Health Plans.
- Interact with internal Corporate, Health Plan, and external medical society personnel to assist with development of clinical programs.
- Interact with organizations and State and Specialty Society points of contact as needed.
- May be required to travel
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Bachelor’s degree in Healthcare Administration, Nursing, related field or equivalent experience. 4+ years of program development and management experience. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff. Managed care experience preferred.
License/Certification: LPN or RN license. Valid driver's license.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
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.