Clinical Innovation & Program Manager

Centene; United States; Remote; USD 86,000 - 155,000; Full time

Job summary

A leading healthcare organization seeks a Remote Clinical Innovation & Program Manager to enhance clinical quality and provider satisfaction. This role involves managing projects, analyzing data, and leading initiatives to improve healthcare services for vulnerable populations. The ideal candidate will have a Master's degree and extensive experience in managed care, with strong skills in project implementation and data analysis.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Arrangements

Qualifications

• Minimum of 5+ years in managed care required.
• Strong knowledge of operational, regulatory, clinical, and reporting requirements.

Responsibilities

• Manage relationships with hospitals, providers, clinics, and health plans.
• Lead process improvement initiatives with cross-functional teams.
• Develop and manage projects aimed at improving cost, quality, and service.

Skills

Project Implementation

Trend Analysis

Managed Care

Data Analysis

Education

Master's Degree in Healthcare Administration

Master's Degree in Nursing

Master's Degree in Public Health

Master's Degree in Business Administration

Master's Degree in Healthcare Policy

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 role will focus on improving clinical quality performance, provider satisfaction, member experience, and operational performance, including access to care. You will lead process improvement initiatives using methodologies to analyze current operations and design improved clinical processes. Responsibilities include managing activities related to reprocurement, provider engagement, and regulatory compliance. The role may focus on specific lines of business (Medicaid, Medicare, Marketplace/Commercial) to align enterprise population health goals with business objectives. You will facilitate and manage the adoption and scaling of enterprise population health programs to ensure successful implementation meeting business needs. Continually reevaluate programs to adapt to changing regulations and member populations.

• Manage relationships with hospitals, providers, clinics, delegated groups, and health plans across lines of business.

• Coordinate external activities to enhance provider and member experiences, maximizing efficiency.

• Gather, analyze, and present data on key performance indicators.

• Develop, implement, and manage projects and programs aimed at improving cost, quality, and service.

• Track project progress and implement action plans.

• Prepare and present reports on provider performance.

• Lead process improvement initiatives with cross-functional teams.

• Manage projects focused on cost, quality, and service improvements.

• Align efforts with the organization's vision and strategic plan.

• Oversee activities related to re-procurement, compliance, and performance metrics (RAF, STARS, HEDIS, MCAS, etc.).

• Manage programs to enhance clinical quality, provider satisfaction, member experience, and operational performance, including access to care.

• Perform other duties as assigned and ensure compliance with policies and standards.

Education/Experience:
Master's Degree in Healthcare Administration, Nursing, Public Health, Business Administration, Healthcare Policy, or related field, or equivalent experience. A minimum of 5+ years in managed care is required.
Strong knowledge of operational, regulatory, clinical, and reporting requirements for Managed Care Plans across multiple lines of business.

Experience leading program implementation in managed care and co-leading cross-functional teams. Experience in clinical program development, informatics, data analysis, and interpretation. 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, stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements (remote, hybrid, field, or office). Actual compensation 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 be considered regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.