Process Improvement Specialist (Clinical)

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.
 

Must reside in the state of Michigan.

Auditing experience highly preferred.

Position Purpose: Plan, develop and track process improvement and operational projects related to clinical outcomes for products and ensure integration with delivery systems including service/care coordination

• 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

Education/Experience: Bachelor’s degree in Healthcare, related field, or equivalent experience. 5+ years of process improvement experience, preferably in a managed care environment. Experience in project coordination preferred.

License/Certificates: Current state’s RN, or LCSW. Drivers license preferred.

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