Process Improvement Specialist – Clinical

🔥 0 minutes ago

🚗 Michigan – Remote

🚗 Michigan – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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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

• Plan, develop and track process improvement and operational projects related to clinical outcomes • Ensure integration with delivery systems, including service/care coordination • Serve as the primary subject matter expert for clinical health outcomes • Review clinical member materials, including service coordination brochures, handbook references, and educational leaflets • Serve as a liaison for clinical initiatives including case and disease management, behavioral health, and HEDIS outcome measures • Evaluate analysis and responses on quality measures, including performance development and reporting • Provide recommendations for process improvements • Review internal and external member survey results for operational implications • Collaborate with the analytics team on 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 • Drivers license preferred • Must reside in the state of Michigan • Auditing experience highly preferred

🏖️ Benefits

• Competitive pay • 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