Description
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
***This is a fully remote position with required bi‑annual travel to New York. Candidates must have the flexibility to work a schedule of their choosing within the hours of 6:00 a.m. to 6:00 p.m. Eastern Time.***
Position Purpose: Develop, conduct, administer and analyze clinical training programs, conduct audits of clinical systems entry and/or processes, and assist in development of audit tools
- 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 may be required
Education/Experience: Bachelor’s degree in Nursing, related clinical field or equivalent experience. 4+ years of experience in nursing, training, or auditing in a managed care healthcare setting. Experience in a lead or supervisory role preferred.
License/Certification: Current state nursing license. Driver’s license may be required for certain positions.
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
