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    Clinical Program Manager - Richmond, United States - Centene Corporation

    Centene Corporation
    Centene Corporation Richmond, United States

    2 days ago

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    Description

    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.


    Position Purpose:

    • Responsible for managing and tracking clinical projects that advance the objectives of strategic plan with key provider groups and/or hospital systems by supporting established committees and creating new work teams; including such activities as organizing and publishing agendas, documenting minutes, maintaining work plans and monitoring open action items
    • Works closely with the Regional Medical Director to analyze data and develop and implement key interventions to support the Triple Aim, including developing work plans, workflows, policies and procedures, and serving as workgroup leader when appropriate in order to execute initiatives.
    • Serves as project leader for cross functional initiatives that are intended to drive performance improvement engaging across functional teams as needed to ensure effective communication of project requirements, as well as tracks progress of action plans.
    • Facilitates the development of clinical reports and the delivery of data to key provider partners; as well as develops internal reports to demonstrate progress.
    • Performs detailed analysis of data, workflows, policies, procedures and organization of staff, in order to execute initiatives.
    • May use project management software to support initiatives.
    • Performs other duties as assigned
    • Complies with all policies and standards

    The Clinical Program Manager is responsible for identifying, managing and tracking clinical, quality, correct coding, documentation and data submission projects that advance the objectives of the Health Plan's strategic goals.

    The Clinical Program Manager facilitates the development of internal and external reports and the delivery of data as needed to support and monitor the action plans to accomplish the Triple Aim:     1) to improve member experience, 2) improve the quality of care and 3) to reduce health care costs.


    Education/Experience: Bachelor's Degree in Nursing, International Medical Graduate, Master's Degree in Public Health (MPH), Hospital Administration (MHA) or Business Administration (MBA) or equivalent experience . Five to seven years managed care, hospital or medical group experience, focusing on quality improvement, utilization management, or clinical operations. Experience analyzing and presenting data to drive outcomes. Experience making presentations in group settings. At least two years project management experience of managing a project at any level at a medical group, IPA or health plan setting.


    Louisiana Only:

    Education: Bachelor's degree in Nursing (or higher degree in Nursing); or Master's degree in Public Health (MPH), Master's degree in Health Administration (MHA), Master's in Business Administration (MBA), or equivalent graduate degree


    Licensure:
    Active and unencumbered Registered Nurse licensure in Louisiana or Compact licensure


    Experience:

    5-7 years of managed care, hospital or medical group; focusing on quality improvement, utilization management, case management, or clinical operations.

    Project management experience at a medical group, IPA, or health plan. Experience analyzing and presenting data to drive outcomes. At least 2 years' management experience.


    Residency:
    LA residency is required.


    Behavioral Health Only:

    Education/Experience: Master's degree in Psychology, Social Work, Counseling, or Nursing. Five to seven years of prior managed care experience and/or experience working with provider groups preferred.


    License/Certification: Licensed behavioral health clinician (LMFT, LCSW, LPC, Psychologist) or RN with experience in a psychiatric setting required.


    Health Net of California Only:

    Education/Experience: Bachelor's Degree in Nursing, International Medical Graduate, Master's Degree in Public Health (MPH), Hospital Administration (MHA) or Business Administration (MBA) or equivalent experience. Five to seven years managed care, hospital or medical group experience, focusing on quality improvement, utilization management, or clinical operations. Experience analyzing and presenting data to drive outcomes. Experience making presentations in group settings. At least two years project management experience of managing a project at any level at a medical group, IPA or health plan setting.


    For Pennsylvania Health and Wellness only: Bachelor's Degree in Nursing or graduate from an accredited school of nursing with an RN license, International Medical Graduate, Master's Degree in Public Health (MPH), Hospital Administration (MHA) or Business Administration (MBA) . Five to seven years managed care, hospital or medical group experience, focusing on quality improvement, utilization management, or clinical operations

    Project management experience at a medical group, IPA, or health plan setting. Experience analyzing and presenting data to drive outcomes. Experience making presentations in group settings. At least two years management experience.


    For Nebraska Total Care only: Bachelor Degree or higher in PT/OT/ST, Pharmacy, Radiology or equivalent. Five to seven years managed care, hospital or medical group experience, focusing on quality improvement, utilization management, or clinical operations. Project management experience at a medical group, IPA, or health plan setting. Experience analyzing and presenting data to drive outcomes. Experience making presentations in group settings. At least two years management experience.


    Pay Range:
    $84, $151,700.00 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.

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