Centene Corp

Clinician Specialist

Centene Corp • $70K — $126K *
US-Anywhere
+ 3 other locationsRemote
Healthcare
Less than 5 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Registered Nurse licensure required
  • 3-5 years related experience needed
  • Experience in developing clinical policies
  • Familiarity with MCG clinical guidelines and CareWeb QI module preferred
  • Strong communication and customer service skills
  • Organized and focused on operational efficiency
  • Ability to multitask and collaborate across teams

Responsibilities

  • Draft and implement clinical guidelines in a standardized format
  • Monitor and organize clinical SOPs and Policies & Procedures
  • Oversee creation of regulatory notices and communication letters
  • Measure and evaluate effectiveness of workflows and processes
  • Research industry best practices for policy development
  • Obtain and summarize departmental performance data
  • Perform additional related duties as assigned

Benefits

  • Competitive pay
  • Health insurance
  • 401K and stock purchase plans
  • Tuition reimbursement
  • Paid time off plus holidays
  • Flexible work options (remote, hybrid, field, or office)
Full Job Description
We are seeking a Clinician Specialist to join our team!

The ideal candidate will bring expertise in:
  • Registered Nurse
  • Experience in Developing Clinical Policies
  • Technological Savvy
  • Excellent Communication and Customer Service Skills
  • Highly Organized with Operational Efficiency
  • Able to Multitask and Collaborate Effectively Across teams
  • Understands Interface of UM with Claims and Coding
  • Self-Starter


Position Purpose: The Clinician Specialist provides clinical and operational support, guidance, and direction to the department related to utilization management and/or case management. The position is responsible to develop, implement, and monitor clinical documentation incorporated into clinical guidelines, policies, and/or procedures that will enable the department to meet and exceed goals, maintain regulatory compliance, improve quality, and promote overall efficiency and effectiveness related to clinical practices.
  • Under the direction of departmental leadership and the Medical Directors, draft clinical guidelines in a standardized format to be utilized by department staff that align with departmental policies and procedures. This may including drafting (and/or creating new entries in the information system) new clinical criteria, as well as reviewing existing criteria for opportunities to modify and edit criteria as needed to ensure guidelines are up to date, and in compliance with state and federal guidelines.
  • Monitor and organize the clinical-focused Department Standard Operating Procedure (SOP) and Policy & Procedures to ensure accuracy, creates new standard operating procedures as needed to facilitate compliance with state and federal regulations. Collaborates with Department leadership and Medical Directors to assist in development or modification of policies & procedures as needed.
  • Oversee the modification or creation of member and provider letters, including determination notices and other regulatory notices, utilized by the department. Suggests and implements modifications as necessary to ensure regulatory compliance as well as improved efficiency. Collaborates with internal stakeholders to ensure impacted staff are educated on new policies, procedures, and processes to ensure successful implementation and compliance.
  • Measure and evaluate effectiveness as it relates to current workflows and processes; compare measurement results to standards and work with the team to improve performance and close identified gaps.
  • Research and identify industry best practices and other relevant available published information to contribute to the development of guidelines, policies, and procedures in order to achieve optimal clinical and/or operational outcomes. Develop and maintain documentation necessary to support consistent, operationally sound processes such as tip sheets, standard operating procedures, audit tools.
  • Obtain data and/or run basic reports to determine department performance related to areas of focus, as directed by department leadership. Summarize data for casual analysis or create basic presentations order to communicate progress to management.
  • Job performance requires fulfilling other incidental or related duties as assigned, including but not limited to collaborating with department trainer and supervisory staff in order to plan for implementations and roll out new policies and/or procedures, reviewing regulatory updates, and participating in a variety of department projects.


We are seeking a Clinician Specialist to join our team!

The ideal candidate will bring expertise in:
  • Registered Nurse
  • Experience in Developing Clinical Policies
  • Technological Savvy
  • Excellent Communication and Customer Service Skills
  • Highly Organized with Operational Efficiency
  • Able to Multitask and Collaborate Effectively Across teams
  • Understands Interface of UM with Claims and Coding
  • Self-Starter


Education/Experience: MA/MS - Masters Degree preferred. 3-5 years related experience required. For Clinical Specialist position in Medical Management: Experience with MCG clinical guidelines required. Prior experience with MCG CareWeb QI guideline modification module preferred.

License/Certification: RN, LMSW, LCSW, LPC, or MHC License required. For Clinical Specialist position in Medical Management: Licensure as RN required.

Pay Range: $70,100.00 - $126,200.00 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

About Centene Corp

Centene Corporation is a managed healthcare enterprise at the forefront of innovation and growth for government-sponsored and commercial healthcare, providing access to fully integrated, high-quality, and cost-effective services that help people lead healthier lives. The company’s local approach addresses the needs of under-insured and uninsured individuals who often lack the resources required to sustain optimal health and wellness. Centene began as a single health plan in Milwaukee, Wisconsin in 1984. After an initial period of growth, Michael Neidorff joined as President and Chief Executive Officer (CEO) in 1996, moving Centene’s headquarters to St. Louis, Missouri, where it still resides today. In the decades since its humble beginnings, Centene has transformed into a publicly-traded Fortune 500 company serving communities across the United States. In fact, Centene provides coverage in all 50 U.S. states. More than 26 million Americans rely on Centene to access a wide range of insurance solutions, including Medicaid, Medicare, TRICARE, correctional, and behavioral health services. Centene prioritizes the development of technology that addresses systemic conditions impacting the whole health needs of underserved populations. As technology plays an increasingly critical role in diagnosing, managing, and treating disease, Centene understands that it enables better health outcomes for members, lessening the burden for providers, and allowing more automation and efficiency for business operations. As a steward of a significant set of data and insights, Centene leverages this data to not only shape but lead the digital transformation of healthcare and improve the patient-provider experience. Centene’s current CEO, Sarah London, and her team are leading the charge in this new age. Sarah London worked within Centene’s Technology Innovation and Modernization division, spearheading the company’s enterprise-wide technology strategy. Now leading Centene, her focus is on building the next generation of products and services and establishing Centene’s long-term growth and value creation. Although Centene has grown into the No. 1 insurer in the U.S. Health Insurance Marketplace, it has never lost its focus on the individual or its passion for community health. Remaining connected to the individuals and families that need care most is central to Centene’s commitment to shaping a better world of healthcare for the communities it serves. Centene also remains connected to the needs of its employees, who make Centene what it is. Through its commitment to diversity, equity, and inclusion practices, Centene promotes a safe and inviting environment above all. Because of Centene’s commitment to excellence and progression in the healthcare industry, it has been recognized as a Top Organization for Diversity by Modern Healthcare magazine, a Leading Disability Employer by the National Organization on Disability, a Best Place to Work for LGBTQ Equality by The Human Rights Campaign Foundation, and a global leader by Bloomberg’s Gender-Equality Index, among many other recognitions. Centene was also named a Top 50 Company for Diversity by DiversityInc and a Top Veteran-Friendly Company by U.S. Veterans Magazine. It has also been listed on FORTUNE® magazine's list of the World's Most Admired Companies for several consecutive years.

Centene Corp Careers

Join the dynamic team at Centene Corp, a leader in the healthcare industry, where your career growth and development are prioritized. At Centene Corp, we offer a range of job opportunities that allow you to make a significant impact on our community and beyond.

Explore a World of Opportunities

Discover the diverse career paths available at Centene Corp, from healthcare services to innovative program development. Our job opportunities span various professional fields, offering positions that cater to your unique skills and ambitions. Whether you're looking for an entry-level role or a senior leadership position, Centene Corp is committed to hiring top talent and fostering a culture of excellence.

Innovation and Leadership at Centene Corp

At Centene Corp, innovation and leadership go hand in hand. We empower our team members to lead with confidence and creativity, driving the company forward through strategic innovation and robust leadership. Our leadership programs are designed to cultivate your skills, helping you to thrive as a professional and make meaningful contributions to our company and the communities we serve.

Internships and Early Career Programs

Kickstart your career with Centene Corp through our internship and early career programs. These opportunities provide hands-on experience and a glimpse into the dynamic world of healthcare management. Internships at Centene Corp are a stepping stone to full-time employment, offering invaluable networking opportunities, mentorship, and the chance to develop your resume and interview skills in a real-world setting.

Commitment to Diversity and Inclusive Culture

Centene Corp is dedicated to maintaining a diverse and inclusive work environment. We believe that diversity fuels innovation and enhances our team's performance. Our diversity training ensures that all team members appreciate and leverage the broad range of experiences and perspectives that each individual brings to the company.

Benefits and Employee Growth

We value our employees' well-being and career aspirations. Centene Corp offers competitive benefits, including health insurance, retirement plans, and professional development programs. Our commitment to your growth is reflected in our continuous learning initiatives and performance management processes that help you achieve your career goals.

Join Our Team

Are you ready to advance your career at Centene Corp? Explore our current job openings and find the position that best matches your skills and interests. We are looking for passionate, curious, and solution-driven team players who are ready to make a difference.

Stay Connected with Centene Careers

Keep up to date with the latest career tips, insider perspectives, and industry-leading insights—all from the people who work at Centene Corp. Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding opportunities that await you at Centene Corp.

SEARCH CENTENE JOBS

Centene Corp is not just a company—it's a place where you can shape your future and impact the lives of millions. Join us in our mission to transform the health of the community, one person at a time.
Learn more about Centene Corp
Size
72,500 employees
Market Cap
$46.5 billion
Industry
Healthcare
Net Income
$1.8 billion
Founded
1984
5 Year Trend
+25.4%
Revenue
$111.1 billion
NASDAQ
CNC
* Ladders Estimates

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