Clinical Program Manager

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $87.7k - $157.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Clinical Operations

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Manage and track clinical, quality, correct coding, documentation, and data submission projects advancing the Health Plan's strategic goals • Support established committees and create new work teams • Organize and publish agendas, document minutes, maintain work plans, and monitor open action items • Work with the Regional Medical Director to analyze data and develop and implement interventions supporting the Triple Aim • Develop work plans, workflows, policies, and procedures • Serve as workgroup leader when appropriate to execute initiatives • Lead cross-functional performance improvement initiatives and engage functional teams to ensure effective communication of project requirements • Track progress of action plans • Facilitate development of clinical, internal, and external reports and deliver data to provider partners • Perform detailed analysis of data, workflows, policies, procedures, and staff organization • Use project management software to support initiatives • Perform other duties as assigned

🎯 Requirements

• Must live in Indiana • Clinical RN highly preferred • Indiana (MHS) Medicaid experience preferred • Understanding of clinical pathway • Experience with Indiana Medicaid, NCQA, CMS, UM appeals/grievances, delegated/vendor oversight, or health plan audit readiness preferred • 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 of 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 of project management experience managing a project at any level at a medical group, IPA, or health plan setting • Ability to comply with all policies and standards

🏖️ Benefits

• Competitive pay • Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation