Clinician Specialist

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🌶️ New Mexico, Missouri – Remote

🌶️ New Mexico – Remote 🏰 Missouri – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

Healthcare Insurance • Non-profit • Social Impact

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

• Provides clinical and operational support, guidance, and direction to the department related to utilization management and/or case management • Develops, implements, and monitors clinical documentation incorporated into clinical guidelines, policies, and/or procedures • Drafts clinical guidelines in a standardized format to be utilized by department staff that align with departmental policies and procedures • Monitors and organizes the clinical-focused Department Standard Operating Procedure (SOP) and Policy & Procedures • Collaborates with Department leadership and Medical Directors to assist in development or modification of policies & procedures • Oversees the modification or creation of member and provider letters • Collaborates with internal stakeholders to ensure impacted staff are educated on new policies, procedures, and processes • Measures and evaluates effectiveness as it relates to current workflows and processes • Researches and identifies industry best practices to contribute to the development of guidelines, policies, and procedures • Develops and maintains documentation necessary to support consistent, operationally sound processes

🎯 Requirements

• Registered Nurse • Experience in Developing Clinical Policies • Technological 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 • MA/MS – Masters Degree preferred • 3-5 years related experience required • Experience with MCG clinical guidelines required • Prior experience with MCG CareWeb QI guideline modification module preferred • RN, LMSW, LCSW, LPC, or MHC License required

🏖️ 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