Clinical Innovation & Program Manager

PA Health & Wellness; Pennsylvania; Remote; USD 86,000 - 155,000; Full time

Job summary

An established industry player is seeking a Clinical Innovation & Program Manager to drive meaningful change through data and quality initiatives. In this remote role, you will leverage your expertise in project implementation and managed care to enhance provider performance and member satisfaction. You will lead cross-functional teams, manage key relationships, and oversee programs that align with business goals. This position offers a unique opportunity to impact the health services landscape significantly while enjoying a flexible work environment and a comprehensive benefits package.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• Master's Degree in a relevant field or equivalent experience required.
• 5+ years of managed care experience with strong knowledge of regulatory requirements.

Responsibilities

• Lead process improvement initiatives to enhance clinical quality and operational performance.
• Manage relationships with providers and coordinate activities to improve member experiences.

Skills

Project Implementation

Trend Analysis

Managed Care

Data Interpretation

Process Improvement

Education

Master's Degree in Healthcare Administration

5+ years of managed care experience

Job description

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.

Centene is Hiring a Remote Clinical Innovation & Program Manager — Drive Meaningful Change Through Data, Quality, and Innovation!

Use your expertise in project implementation, trend analysis, and managed care to lead cross-functional initiatives that enhance HEDIS, CAHPS, and provider performance. The ideal candidate will have experience identifying care gaps, working with provider-facing teams, and managing programs that support our most vulnerable populations.

Position Purpose

This position will play a significant role in improving clinical quality performance, provider satisfaction, member experience, and operational performance, including access to care. You will lead and direct process improvement initiatives using process improvement methodologies to analyze current operations and design clinical processes. Manage activities related to reprocurement, provider engagement, and regulatory compliance. The role may focus on specific lines of business (Medicaid, Medicare, Marketplace/Commercial) to ensure alignment of enterprise population health programs with business goals. Facilitate and manage the adoption and scaling of enterprise population health programs to meet business needs. Continuously reevaluate programs to ensure they meet evolving regulatory requirements and the needs of the member population.

• Manage relationships with hospitals, providers, clinics, and delegated groups, as well as with Health Plans and specific lines of business.
• Coordinate external activities to enhance provider and member experiences, maximizing efficiency.
• Gather, analyze, track, and present data on key performance indicators.
• Develop, implement, and manage external projects aimed at improving cost, quality, and service.
• Track project progress and implement action plans.
• Prepare and present reports on provider performance.
• Co-lead process improvement initiatives with cross-functional teams.
• Co-manage projects focused on cost, quality, and service improvements.
• Ensure all efforts align with the organization's vision and strategic plan.
• Manage activities related to re-procurement, regulatory compliance, and performance metrics (RAF, STARS, HEDIS, MCAS, etc.).
• Oversee programs to improve clinical quality, provider satisfaction, member experience, and operational performance, including access to care.
• Perform other duties as assigned.
• Ensure compliance with policies and standards.

Education/Experience

Master's Degree in Healthcare Administration, Nursing, Public Health, Business Administration, Healthcare Policy, or equivalent field, or equivalent experience. 5+ years of managed care experience. Strong knowledge of operational, regulatory, clinical, and reporting requirements for Managed Care Plans (MCP) across multiple lines of business. Experience leading program implementations and co-leading cross-functional teams. Experience in clinical program development, informatics, data interpretation, and analysis. Clinical license (e.g., RN, LCSW, LCPC, LICSW, Ph.D., Psy.D., PMHNP, CNS, LMHC) preferred.

Pay Range

$86,000.00 - $154,700.00 per year

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements (remote, hybrid, field, or office). Actual pay will be based on skills, experience, education, and other factors. Total compensation may include additional incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Applicants with arrest or conviction records will be considered in accordance with applicable laws.