Collaborative Health Systems View Company Profile
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, youxe2x80x99ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Collaborates with Quality, Operation business owners and/or cross-functional work groups to develop and implement standards, policy and procedures, work flows, and decision support systems to support improvements of clinical and administrative operations. Manages the develop and oversee clinical and quality programs. Utilizes advanced project management skills and builds strong organizational relationships to implement and manage initiatives. Provides direction to ensure the successful completion of industry programs. Addresses quality improvement related to key program metric outcomes, partnerships, and new initiatives designed to improve the reach and engagement of physician partners and members. Creates and implements strategic clinical and quality programs. Works with the ACO leadership to ensure the program strategy meets goals of the organization. Oversees aspects of program planning, management, and execution. Serves as the escalation point for program concerns and questions from participating physician practices for clinical needs. Works directly with practice teams and internal staff to resolve issues and create risk mitigation plans. Escalates well-formulated issues and risks to leadership. Effectively communicates business and technology issues and solutions. Drives program-level quarterly and annual reporting as per the program requirements. Utilizes data reporting to increase visibility and proactive monitoring of the program performance. Reports program progress to all levels of the organization. Actively engages in clinical and quality programs to ensure the appropriate program development and changes are communicated to leadership and participating physicians. Manages areas, such as risk, that affect the practice’s participation in the program in a proactive manner. Prepares strategic analysis of potential business and/or operational opportunities as needed. Develops internal and external clinical and quality based programs through all phases of the project lifecycle to increase coordination of care and communication for all health care partners and patients involved. Encourages collaboration and ensures that all viewpoints are represented and explored. Builds effective working relationships with physician practices and healthcare partners. Works with internal and external team members to implement identified programs and best practices. Actively participates and contributes to the quality and clinical Subcommittees; plays an integral role as a member os clinical subcommittees. Provides and coordinates training to Market Managers, Quality Practice Advisors and Patient Care Advocates to support providers in program implementation and management. Monitors clinical program performance through activity and analytic reports. Identifies trends and patterns in utilization and opportunities for program development. Performs other duties as assigned Complies with all policies and standards Education/Experience: Bachelor’s Degree Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field. required: 5+ years managed care experience related to HEDIS OR GPRO record review, quality improvement, medical coding or, transferable skill sets that demonstrates the ability to perform the role. required 5+ years of experience in direct program development, program management, and/or project management, preferably in a healthcare environment required 2+ years Managed care, utilization management, care coordination, disease management, Medicare, Medicaid, DSNP and dual eligible experience. preferred 2+ years Designing, developing and implementing STARS, CAHPS, HEDIS and other enterprise quality related programs across a variety of settings including: defining the eligible population, service mix, delivery system configuration and financing. preferred 2+ years Integrating behavioral, clinical, social, and community health care for members with multiple chronic conditions. preferred 2+ years Working with multiple market leaders to coordinate consistent quality and clinical initiatives. preferred 2+ years Conducting assessments, contractual reviews, and business plans for new quality improvement initiatives, including internally or vendor sourced clinical /quality programs, and/or the integration of innovative approaches to defined programs to improve healthcare quality preferred RN – Registered Nurse – State Licensure and/or Compact State Licensure Upon Hire required and APRN-BC – Advanced Practice Registered Nurse, Board Certified Upon Hire required ACNP-BC – Acute Care Nurse Practitioner – ANCC Upon Hire required Pay Range: $67,400.00 – $121,300.00 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. 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.