Note: The job is a remote job and is open to candidates in USA. Managed Health Services (MHS), part of Centene’s Medical Management/Health Services team, supports Medicaid members and health plan initiatives. The Clinical Program Manager manages clinical, quality, coding, documentation, and data submission projects; analyzes data, coordinates cross-functional teams, develops reports and interventions, and tracks action plans to improve member experience, care quality, and healthcare costs.
Responsibilities
- Responsible for managing and tracking clinical projects that advance the objectives of strategic plan with key provider groups and/or hospital systems by supporting established committees and creating new work teams; including such activities as organizing and publishing agendas, documenting minutes, maintaining work plans and monitoring open action items
- Works closely with the Regional Medical Director to analyze data and develop and implement key interventions to support the Triple Aim, including developing work plans, workflows, policies and procedures, and serving as workgroup leader when appropriate in order to execute initiatives
- Serves as project leader for cross functional initiatives that are intended to drive performance improvement engaging across functional teams as needed to ensure effective communication of project requirements, as well as tracks progress of action plans
- Facilitates the development of clinical reports and the delivery of data to key provider partners; as well as develops internal reports to demonstrate progress
- Performs detailed analysis of data, workflows, policies, procedures and organization of staff, in order to execute initiatives
- May use project management software to support initiatives
- Performs other duties as assigned
- Complies with all policies and standards
Skills
- Must live in Indiana
- Understanding clinical pathway
- Education/Experience: Bachelor's Degree in Nursing, International Medical Graduate, Master's Degree in Public Health (MPH), Hospital Administration (MHA) or Business Administration (MBA) or equivalent experience
- Five to seven years managed care, hospital or medical group experience, focusing on quality improvement, utilization management, or clinical operations
- Experience analyzing and presenting data to drive outcomes
- Experience making presentations in group settings
- At least two years project management experience of managing a project at any level at a medical group, IPA or health plan setting
- Indiana (MHS) Medicaid Experience Preferred
- Clinical RN Highly preferred
- Experience with Indiana Medicaid, NCQA, CMS, UM appeals/grievances, delegated/vendor oversight, or health plan audit readiness is preferred
- Clinical RN Highly Preferred
- Experience with Indiana Medicaid, NCQA, CMS, UM appeals/grievances, delegated/vendor oversight, or health plan audit readiness is preferred
Benefits
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- A flexible approach to work with remote, hybrid, field or office work schedules
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