Lead Clinical Operations Specialist

Centene Corporation • Northampton, MA

3d • $87,000 - $161,300 • Remote

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN STATE OF MISSOURI IDEAL CANDIDATE WILL HAVE BEHAVIORAL HEALTH AND PROGRAM DEVELOPMENT EXPERIENCE Position Purpose: Leads and oversees the clinical function and implements clinical initiatives and/or programs. Works alongside senior leadership team to support ensuring all clinical programs and processes are consistent with National Committee for Quality Assurance (NCQA) guidelines, state mandates, and/or government contract requirements. Leads and oversees the implementation of clinical initiatives and/or programs to improve care coordination, efficiency, and health and quality outcomes Identifies, manages, and tracks clinical, quality, documentation and data submission projects to achieve strategic objectives Collects and analyzes data on utilization, outcomes, safety, and costs to determine trends and help identify areas of improvement Reviews development plans, policies, and procedures needed for strategic initiatives, programs with senior leadership team, and improve processes and/or health and quality outcomes based on collected data Provides guidance and insight to clinical operations junior team members on clinical processes and initiatives Develops reporting for senior leadership team on data needed to support and monitor initiatives and programs and provides recommendations to improve member experience, improve the quality of care, and reduce health care costs Works with senior leadership team to support clinical initiatives and/or programs are in accordance with National Committee for Quality Assurance (NCQA) guidelines, state mandates, and/or government contract requirements Works cross functionally to identify areas for process improvements to manage costs and support initiatives to improve health and quality outcomes May Assist care operations senior leadership team with onboarding, hiring, and training clinical operations team members Performs other duties as assigned Complies with all policies and standards

Requirements

• Requires a Bachelor's degree and 5 – 7 years of related experience.
• Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

Nice To Haves

• IDEAL CANDIDATE WILL HAVE BEHAVIORAL HEALTH AND PROGRAM DEVELOPMENT EXPERIENCE

Responsibilities

• Leads and oversees the clinical function and implements clinical initiatives and/or programs.
• Works alongside senior leadership team to support ensuring all clinical programs and processes are consistent with National Committee for Quality Assurance (NCQA) guidelines, state mandates, and/or government contract requirements.
• Leads and oversees the implementation of clinical initiatives and/or programs to improve care coordination, efficiency, and health and quality outcomes
• Identifies, manages, and tracks clinical, quality, documentation and data submission projects to achieve strategic objectives
• Collects and analyzes data on utilization, outcomes, safety, and costs to determine trends and help identify areas of improvement
• Reviews development plans, policies, and procedures needed for strategic initiatives, programs with senior leadership team, and improve processes and/or health and quality outcomes based on collected data
• Provides guidance and insight to clinical operations junior team members on clinical processes and initiatives
• Develops reporting for senior leadership team on data needed to support and monitor initiatives and programs and provides recommendations to improve member experience, improve the quality of care, and reduce health care costs
• Works with senior leadership team to support clinical initiatives and/or programs are in accordance with National Committee for Quality Assurance (NCQA) guidelines, state mandates, and/or government contract requirements
• Works cross functionally to identify areas for process improvements to manage costs and support initiatives to improve health and quality outcomes
• May Assist care operations senior leadership team with onboarding, hiring, and training clinical operations team members
• Performs other duties as assigned
• Complies with all policies and standards

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level