Process Improvement Specialist (Clinical)

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 reside in the state of Michigan. Auditing experience highly preferred.

About the Role

Plan, develop, and track process improvement and operational projects related to clinical outcomes for products and ensure integration with delivery systems including service/care coordination. Serve as the primary subject matter expert for clinical health outcomes.

Responsibilities

• Review of all clinical member materials, including service coordination brochures, handbook references, and educational leaflets.
• Serve as a liaison for all clinical initiatives including case and disease management, behavioral health, and HEDIS outcome measures.
• Evaluate the analysis and responses on all quality measures including performance development and reporting, and provide recommendations.
• Review member survey results from internal as well as external sources for implications to operations and make recommendations for process improvements accordingly.
• Collaborate with analytics team on identified process improvement reporting and scheduling.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements

• Bachelor’s degree in Healthcare, related field, or equivalent experience.
• 5+ years of process improvement experience, preferably in a managed care environment.
• Experience in project coordination preferred.
• Current state’s RN or LCSW license.
• Driver’s license preferred.

Pay

$70,100.00 - $126,200.00 per year. 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

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field, or office work schedules

Benefits may be subject to program eligibility.