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.
Interpret and present program results and develop data-driven analysis and metrics used to measure effectiveness and ROI of all current and new programs
Partner with various staff, along with internal and external departments on provider education and outreach; determine where there are gaps and work to develop and deploy education efforts
Partner with regional leadership for providers requiring a clinical interpretation of results related to health plan reporting, data and quality incentive payments; facilitate discussions to make recommendations
Implement and manage procedures for tracking, identifying and problem-solving operational issues, including issues between the provider network, community, and the facility, and make recommendations to solve
Act as the clinical representative in various meetings
Collaborate with staff to identify internal and external opportunities and initiate process changes to increase quality and improve staff, provider and member satisfaction
Serve as resource and liaison on utilization, quality improvement and case management activities
Education/Experience: Master’s in Social Work / Behavioral health. 5+ years of experience in managed care, utilization management, case management, or quality improvementLicense/Certification: LPC, LCSWFor Behavioral Health: LPC, LCSW, LHMC, LMFTNorth Carolina: LMHC or state equivalentPay Range: $66,100.00 - $118,900.00 per yearCentene 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.
Full-time