Clinical Nurse Liaison

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.

(30 hours per week. May be open to 3 (10) hour days).

• 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
• Collects, summarizes, and delivers provider quality performance data to strategize/coach on opportunities for provider improvement and gap closure. Educates provider practices on appropriate HEDIS measures, medical record documentation guidelines, and HEDIS ICD-10 CPT coding in accordance with State, Federal, and NCQA requirements.
• Educates, supports, and resolves provider practice sites’ issues around HEDIS, Pharmacy, Member Experience, and Administrative measures.

Education/Experience:
LPN or LVN license. RN license preferred. 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. Experience working in managed care, utilization management, case management, or quality improvement preferred.

For Trillium Community Health Plan - Oregon Market:
Education/Experience: LPN or LVN license. RN license preferred. 4+ years of clinical nursing experience working with Medicaid or the uninsured. Experience in conflict management or data reporting and evaluation. Experience working in managed care, utilization management, case management, or quality improvement preferred.

Additional Responsibilities Include:

• Develop, review, validate, update, publish, and present various policies and procedures to ensure alignment with best practices and organizational goals, and compliance with all applicable laws, regulations, and accreditation standards.
• Researches and submits deliverables to the State and other Organization
• Minimal travel required (approx 1 - 3 times 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