Position Purpose: Develop, recommend and implement interventions at the practice and membership level to improve clinical quality and operational efficiency. Collaborate with practices to facilitate redesign efforts, support care teams, introduce population health management and support achievement towards improved financial, process and clinical outcomes.
Serve as a liaison to practices to provide on-site and remote assistance and facilitation to the clinicians, care teams and their associated practices to drive improvement in clinical quality and operational efficiency.
Develop and execute set of intervention work plans to drive practice improve quality measures and transformation.
Develop and implement workflow design and redesign, including electronic health record (EHR) optimization, clinical documentation, billing practices, assessments, financial analyses, and financial performance improvement and reporting.
Develop and implement changes to root causes of financial and quality underperformance and communicate strategies to providers and provider groups.
Review and interpret summary data and performance reports such as pay for performance, HEDIS and medical cost ratio and develop data driven provider performance strategies.
Actively participate in cross-functional teams to conduct work and resolve enterprise and regional issues
Education/Experience: Bachelor’s degree in nursing, healthcare administration, business, public health or related field or equivalent experience. Master’s in healthcare administration or public health preferred. 4+ years of analysis or provider/medical operations experience, preferably in the healthcare or managed care industry.
License/Certification: Licensed Vocational Nurse (LVN), Registered Nurse (RN), or Certified Professional Coder (CPC) license preferred. Certified Professional in Healthcare Quality (CPHQ), Master of Health Administration (MHA), Master of Public Health (MPH), or Project Management Program (PMP) or Lean/Six Sigma (Green or Black Belt) certification preferred.
For formal consideration please click HERE to apply.
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.
Internal Number: 1128895
About Health Net of California
Centene Corporation, a Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on under-insured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans). The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.