Note: The job is a remote job and is open to candidates in USA. Centene is a diversified national healthcare organization, and it is seeking a Process Improvement Specialist (Clinical) to support its Medical Management/Health Services team. The role focuses on planning, developing, tracking, and improving clinical outcome processes, coordinating clinical initiatives, evaluating quality measures and member survey results, and collaborating on reporting.
Responsibilities
- Serve as the primary subject matter expert for clinical health outcomes
- Review of all clinical member materials, including service coordination brochures, handbook references, and educational leaflets
- Serve as a liaison for all clinical initiatives including, case and disease management, behavioral health and HEDIS outcome measures
- Evaluate the analysis and responses on all quality measures including, performance development and reporting, and provide recommendations
- Review member survey results from internal as well as external sources for implications to operations and make recommendations for process improvements accordingly
- Collaborate with analytics team on identified process improvement reporting and scheduling
- Performs other duties as assigned
- Complies with all policies and standards
Skills
- Must reside in the state of Michigan
- Bachelor's degree in Healthcare, related field, or equivalent experience
- 5+ years of process improvement experience, preferably in a managed care environment
- Current state's RN, or LCSW
- Auditing Experience Highly Preferred
- Experience in project coordination preferred
- Drivers license preferred
Benefits
- Competitive benefits
- Health insurance
- 401K
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- A flexible approach to work with remote, hybrid, field or office work schedules
Company Overview