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 be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
**Experience with Utilization Management is preferred.
Position Purpose: Responsible for developing, implementing, monitoring and measuring performance of strategic initiatives aimed at enhancing quality of care, improving health outcomes, and achieving savings through reduction of inappropriate utilization. This position will drive value creation efforts by ensuring efficient and effectively program implementation as well as optimal reporting and analysis capabilities to track and trend performance, automate activities, and identify new population health management opportunities.
- Responsible for the overall planning, management, and effective implementation and support of initiatives to create value across clinical operations areas such as care management, utilization management, outreach programs, and other services related to both physical and behavioral health.
- Collaborates with Senior and Executive leadership in the identification of high-value performance improvement opportunities within Clinical Operations aimed at improving member health outcomes, increasing quality of care and member satisfaction, and reducing inappropriate utilization / medical spend.
- Manages portfolio of initiatives aimed at creating value in areas of medical management. Develops thoughtful, elegant solutions aligned with organizational priorities and strategic goals.
- Creates master implementation plan of the department’s strategic roadmap, drives progress, and evaluates performance of initiatives in order to ensure continuous appropriate prioritization and timely execution of key deliverables.
- Directs a team responsible for innovation, performance improvement, and performance measurement. Builds and nurtures an environment of continuous improvement and collaboration amongst team.
- Assures quality and efficiency of medical management functions (e.g., care management, utilization management, clinical integration) and ensures regulatory compliance.
- Ensures the development of criteria and methods of displaying data (e.g., KPIs, dashboards) to systemically evaluate both qualitative and quantitative attributes of new solutions implemented to track and evaluate the success of clinical interventions on both a macro and micro level.
- Monitors progress of initiatives and ongoing programs and initiates process redesign and related document updates and training when needed in order to make improvements and meet goals.
- Works with leadership within and outside of the department to identify appropriate resources to support goals and remove barriers.
Education/Experience: MA/MS - Masters Degree or equivalent strongly preferred. BA/BS - Bachelors Degree Required. 5-8 years related experience in Managed Care or other Healthcare environment required. Strong leadership, project management, analytical, written, and verbal communication skills. Strong Operational experience in understanding the interdependencies within the Healthcare Ecosystem, including processes, systems, and regulatory environment. Proven ability to lead change and innovation in dynamic environment.
Pay Range: $113,100.00 - $209,100.00 per year
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
