Clinical Nurse Liaison

Centene•Rosedale, NY

6d•$34 - $61

About The Position

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: Serve as a liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams Implement and manage procedures for tracking, identifying and problem-solving operational issues. Interpret and present program results and develop data-driven analysis and metrics used to measure effectiveness and ROI of all current and new products. Act as the clinical representative in various meetings. Collaborate with staff to identify internal and external opportunities and initiate process changes to increase quality and improve staff, provider and member satisfaction. Serve as a resource and liaison on utilization, quality improvement, and case management activities. Partner with various staff, along with internal and external departments on provider education and outreach. Partner with regional leadership for providers requiring a clinical interpretation of results related to health plan reporting, data, and quality incentive payments. Support community and member initiatives with a focus on at risk targets. 50% travel required. Performs other duties as assigned Complies with all policies and standards

Requirements

LPN or LVN license.
4+ years of clinical nursing experience, preferably in a large primary care office or clinic setting working with Medicaid or the uninsured.
Experience in conflict management or data reporting and evaluation.

Nice To Haves

RN license preferred.
Experience working in managed care, utilization management, case management, or quality improvement preferred.

Responsibilities

Serve as a liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams
Implement and manage procedures for tracking, identifying and problem-solving operational issues.
Interpret and present program results and develop data-driven analysis and metrics used to measure effectiveness and ROI of all current and new products.
Act as the clinical representative in various meetings.
Collaborate with staff to identify internal and external opportunities and initiate process changes to increase quality and improve staff, provider and member satisfaction.
Serve as a resource and liaison on utilization, quality improvement, and case management activities.
Partner with various staff, along with internal and external departments on provider education and outreach.
Partner with regional leadership for providers requiring a clinical interpretation of results related to health plan reporting, data, and quality incentive payments.
Support community and member initiatives with a focus on at risk targets.
Performs other duties as assigned
Complies with all policies and standards