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.
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.See More
Valid through: 11/12/2021