Clinician Specialist

About the role

The Ideal Candidate Will Bring Expertise In: Registered Nurse
Experience in Developing Clinical Policies
Tech-Savvy
Excellent Communication and Customer Service Skills
Highly Organized with Operational Efficiency
Able to Multitask and Collaborate Effectively Across Teams
Understands Interface of UM with Claims and Coding
Self-Starter

Position Purpose

The Clinician Specialist provides clinical and operational support, guidance, and direction to the department related to utilization management and/or case management. The position is responsible to develop, implement, and monitor clinical documentation incorporated into clinical guidelines, policies, and/or procedures that will enable the department to meet and exceed goals, maintain regulatory compliance, improve quality, and promote overall efficiency and effectiveness related to clinical practices.

Responsibilities

• Draft clinical guidelines in a standardized format to be utilized by department staff that align with departmental policies and procedures.
• Monitor and organize the clinical-focused Department Standard Operating Procedure (SOP) and Policy & Procedures to ensure accuracy, creates new standard operating procedures as needed to facilitate compliance with state and federal regulations.
• Collaborates with Department leadership and Medical Directors to assist in development or modification of policies & procedures as needed.
• Oversee the modification or creation of member and provider letters, including determination notices and other regulatory notices, utilized by the department.
• Suggests and implements modifications as necessary to ensure regulatory compliance as well as improved efficiency.
• Collaborates with internal stakeholders to ensure impacted staff are educated on new policies, procedures, and processes to ensure successful implementation and compliance.
• Research and identify industry best practices and other relevant available published information to contribute to the development of guidelines, policies, and procedures in order to achieve optimal clinical and/or operational outcomes.
• Develop and maintain documentation necessary to support consistent, operationally sound processes such as tip sheets, standard operating procedures, audit tools.
• Obtain data and/or run basic reports to determine department performance related to areas of focus, as directed by department leadership.
• Summarize data for casual analysis or create basic presentations order to communicate progress to management.

Qualifications

• MA/MS – Masters Degree preferred.
• 3-5 years related experience required.
• Licensure as RN required.

Skills

• Registered Nurse
• Experience in Developing Clinical Policies
• Tech-Savvy
• Excellent Communication and Customer Service Skills
• Highly Organized with Operational Efficiency
• Able to Multitask and Collaborate Effectively Across Teams
• Understands Interface of UM with Claims and Coding
• Self-Starter

Pay

$70,100.00 - $126,200.00 per year

Benefits

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.

Equal Opportunity Employer

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.