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.
Position Purpose: Perform quality improvement activities including, but not limited to, member and or provider outreach and or education, care gap closure documentation, medical record data abstraction and over-reads of HEDIS and other quality related measures.
This is a hybrid role and requires field visits. Candidates must reside in Gainesville, Jacksonville or Tallahassee Florida.
- Conducts member and/or provider outreach to close quality care gaps for CMS Medicare Advantage Stars, Medicaid, and Marketplace Quality measures.
- Coordinates and facilitates member access to various healthcare providers for services, as necessary.
- Enters pertinent clinical information into various medical management systems.
- Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.
- Educates providers on HEDIS measures and documentation requirements based on provider medical records
- Collects and summarizes performance data and identifies opportunities for improvement to educate providers and improve overall quality metric performance.
Education/Experience:
A bachelor's degree in Health Care, Nursing, Public Health Administration or Business, or equivalent work experience is required. Health science related, preferably nursing.
3 years of experience. Some experiences functioning as a lead - 2+ years; 5 experience working in a managed care environment. Project management experience is preferred.
This is a hybrid role and requires field visits. Candidates must reside in Gainesville, Jacksonville or Tallahassee Florida.
Licenses/Certifications:
LPC-Licensed Professional Counselor or LCPC - Licensed Clinical Professional Counselor Upon Hire required or
LCSW- License Clinical Social Worker Licensed Clinical Social Worker Upon Hire required or
RN - Registered Nurse - State Licensure and/or Compact State Licensure Registered Nurse
Pay Range: $55,100.00 - $99,000.00 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 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. Total compensation may also include additional forms of incentives.
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