Clinician Specialist

Job not on LinkedIn

🔥 16 hours ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Provide clinical and operational support, guidance, and direction related to utilization management and/or case management • Develop, implement, and monitor clinical documentation incorporated into clinical guidelines, policies, and procedures • Draft standardized clinical guidelines aligned with departmental policies and procedures • Draft new clinical criteria and review and update existing criteria for compliance with state and federal guidelines • Monitor and organize clinical-focused department SOPs and policies and procedures • Create new SOPs as needed to facilitate regulatory compliance • Collaborate with department leadership and Medical Directors on policy and procedure development or modification • Oversee modification or creation of member and provider letters, determination notices, and other regulatory notices • Coordinate with internal stakeholders to educate impacted staff on new policies, procedures, and processes • Measure and evaluate workflow and process effectiveness, identify gaps, and improve performance • Research industry best practices and published information to support guideline, policy, and procedure development • Develop and maintain tip sheets, SOPs, audit tools, and other operational documentation • Obtain data and run basic reports to assess department performance • Summarize data and create basic presentations to communicate progress to management • Collaborate with trainers and supervisory staff on implementations and rollout of new policies and procedures • Review regulatory updates and participate in department projects

🎯 Requirements

• Strong project management and organizational skills, with the ability to manage multiple priorities and meet regulatory deadlines • In-depth knowledge of Utilization Management processes, prior authorization tools, and regulatory compliance requirements • Strong communication and stakeholder engagement skills • Proficiency in data analysis, reporting tools, and software used to track and communicate regulatory and operational information • Ability to work independently with minimal direction while navigating ambiguity and changing priorities • An active RN license • Candidates must reside in Oklahoma • 3-5 years related experience required • MA/MS – Masters Degree preferred • Experience with MCG clinical guidelines required for Clinical Specialist position in Medical Management • Prior experience with MCG CareWeb QI guideline modification module preferred • RN, LMSW, LCSW, LPC, or MHC License required • Licensure as RN required for Clinical Specialist position in Medical Management • Standard schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m.

🏖️ Benefits

• Health insurance • 401K plan • 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 • Diversity-focused equal opportunity employer