Clinical Improvement Specialist

Company Description

CenCal Health is a publiclyfunded managed care organization that provides health care coverage for residents in Santa Barbara and San Luis Obispo counties. We are currently seeking a Claims Customer Service Supervisor in our Santa Barbara office location.

Job Description

• Were looking for a RN that likes to make visits to local providersclinics to upgrade our quality of care for our members. Need to have 2+ years experience in healthcare field, outpatient care a plus. Are you good at understanding clinical issues and medical diagnosis? Performed chart audits? Weve got an opportunity for you!

• Qualifications

  This role has a requirement of being in office 1 day per month in Santa Barbara

  • Strong teamoriented ability to
    connect with quality improvement staff, and establish and maintain positive
    professional working relationships, both within and outside CenCal Health

  • Knowledge of quality improvement
    theory, strategy, and practical methods to achieve rapidcycle improvement;

  • Ability to perform effectively under
    pressure and maintain focus on daily responsibilities for longterm projects;

  • Ability to establish and nurture
    positive professional working relationships with CenCal Health customers;

  • Ability to evaluate data,
    establish facts and draw valid conclusions;

  • Effective oral and written
    communication skills;

  • Ability to perform HEDIS medical

  • Education and Experience

    • Bachelor’s Degree in ajobrelated field

    • 2 years’ experience in a managed care quality management setting (or combination of academic, professional or work experience that demonstrates ability to perform the duties of the position.

    • Current and unrestricted Registered Nurse (RN) license to practice in California

    • DESIRED:

      • A graduate degree in a
        healthcare or managementrelated discipline is preferred (e.g., MBA, MPH)

      • Certified Professional in
        Healthcare Quality (CPHQ) or similar certification

      • HEDIS medical record data abstraction

      • 
        An emphasis in MedicaidMediCal managed care

        Salary Range: $78,562 $121,771
        
        

        Additional Information

        To view our current job openings, please visit our website at www.cencalhealh.org.