Clinical Program Manager

Centene Corp.; Indiana, Northern (PA, KY); Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedule (remote, hybrid

Field or office work

Job summary

Centene Corp. is seeking a clinical professional to manage and track clinical projects within Medical Management/Health Services.

The role emphasizes data analysis, strategic interventions, and collaboration with provider groups and hospital systems to drive improvements and compliance with policies. The candidate should have a Nursing degree (BN/BSN), experience in managed care or hospital settings, and strong project management and data presentation skills.

Qualifications

• Bachelor's Degree in Nursing required.
• International Medical Graduate preferred.
• Master's Degree in Public Health (MPH), Hospital Administration (MHA) or Business Administration (MBA) or equivalent experience.
• 5–7 years managed care, hospital or medical group experience focusing on quality improvement, utilization management, or clinical operations.
• Experience analyzing and presenting data to drive outcomes.
• Experience making presentations in group settings.
• At least two years project management experience.

Responsibilities

• Manage and track clinical projects that advance the objectives of the strategic plan with provider groups and hospital systems.
• Collaborate with Regional Medical Director to analyze data and develop and implement key interventions to support the Triple Aim.
• Develop workflows, policies and procedures, and serve as workgroup leader when appropriate to execute initiatives.
• Facilitate development of clinical reports and deliver data to key provider partners; develop internal reports to demonstrate progress.
• Use project management principles to organize activities and monitor action items.

Skills

Quality improvement

Utilization management

Clinical operations

Data analysis

Presentation skills

Education

Bachelor's Degree in Nursing

MPH

MHA

MBA

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.

Must live in Indiana Indiana (MHS) Medicaid experience preferred Clinical RN Highly preferred Understanding clinical pathway Experience with Indiana Medicaid, NCQA, CMS, UM appeals/grievances, delegated/vendor oversight, or health plan audit readiness is preferred

Position Purpose:

Responsible for managing and tracking clinical projects that advance the objectives of strategic plan with key provider groups and/or hospital systems by supporting established committees and creating new work teams; including such activities as organizing and publishing agendas, documenting minutes, maintaining work plans and monitoring open action items Works closely with the Regional Medical Director to analyze data and develop and implement key interventions to support the Triple Aim, including developing work plans, workflows, policies and procedures, and serving as workgroup leader when appropriate in order to execute initiatives. Serves as project leader for cross functional initiatives that are intended to drive performance improvement engaging across functional teams as needed to ensure effective communication of project requirements, as well as tracks progress of action plans. Facilitates the development of clinical reports and the delivery of data to key provider partners; as well as develops internal reports to demonstrate progress. Performs detailed analysis of data, workflows, policies, procedures and organization of staff, in order to execute initiatives. May use project management software to support initiatives. Performs other duties as assigned. Complies with all policies and standards.

Education/Experience:

Bachelor's Degree in Nursing, International Medical Graduate, Master's Degree in Public Health (MPH), Hospital Administration (MHA) or Business Administration (MBA) or equivalent experience . Five to seven years managed care, hospital or medical group experience, focusing on quality improvement, utilization management, or clinical operations. Experience analyzing and presenting data to drive outcomes. Experience making presentations in group settings. At least two years project management experience of managing a project at any level at a medical group, IPA or health plan setting.

Pay Range:

$87,700.00 - $157,800.00 per year

Benefits:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Equal Opportunity and Diversity:

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.