Remote Clinical Vendor Manager (RN) – California

You could be the one who changes everything for our 26 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: The Clinical Accounts Manager – HNCA is responsible to maximize efficiency of medical management, improve the health care experience for enrollees and promote Health Net medical management with select employer groups. Functions as a leader for assigned health services initiatives handling multiple large-scale complex programs and initiatives. This position is also responsible for activities related to process improvement and project implementation, with a focus on identified employer groups, including planning, development, implementation and monitoring of population programs for the identified population.

• Collects, analyzes, interprets, displays and reports data of employer groups’ utilization experience.
• Functions as clinical liaison to sales team, consultants and employers, acts as a liaison to RFP unit.
• Develops and implements work plans for selected clinical account management employer groups.
• Creates presentations regarding employer utilization with recommendations to control or improve.
• Works with other stakeholders in program planning, implementation and monitoring of program or initiative outcomes.
• Leads and manages multiple complex initiatives that impact the utilization, quality or effectiveness of health care delivery and/or health care services provided to members
• Provides an assessment of programs, initiatives and interventions to determine the effectiveness of activities and makes recommendations to improve outcomes.
• Develops and leads targeted activities to improve HEDIS, CAHPS, provider satisfaction and other identified performance measures.
• Completes project-related communication and other communications, including member/physician mailings, business plans, graphics, minutes and agendas.
• Monitors and analyzes outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met.
• Participates in departmental evaluation, audit and improvement activities.
• Leads, facilitates or participates in relevant committees and work groups; makes presentations; prepares reports, data or other materials for presentation.
• Identifies areas of improvement within the company and works collaboratively with other departments to develop clinical and non-clinical performance improvement projects.
• Researches best practices, national and regional benchmarks, and industry standards.
• In collaboration with Disease Management and Care Management, monitors the effectiveness of the programs on health outcomes. Assesses and participates in the evaluation and revision of Care Management programs to optimize health outcomes.
• In collaboration with executive management, identifies areas of opportunity and/or provider education.
• Communicates with providers, members and community resources as necessary to support the planning, implementation and evaluation of initiatives.
• Performs audit activities as required, participates in establishment of corrective action as necessary.
• Performs other duties as assigned.

Education/Experience: Bachelor’s degree in related health field.
Master’s Degree with Registered Nurse License or Master’s Degree in related health field (i.e. MPH or MPA) preferred. Three to five years managed care, UM and/or case management experience. Experience in compliance, accreditation, service or quality improvement. Complex project management experience

License/Certification: Active and valid and unrestricted Registered Nurse License for applicable State preferred.

Pay range: $82,600 to $148,700 per year

This information reflects the anticipated base salary range for this position based on current national data. Minimums and maximums may vary based on location. Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law. The employee may be eligible for bonuses and other forms of compensation.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.

Job Type: Full-time

Pay: $82,600.00 – $148,700.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Supplemental pay types:

• Bonus pay

Education:

• Bachelor’s (Preferred)

Experience:

• working with vendors: 3 years (Preferred)
• Managed care: 3 years (Preferred)
• project management: 1 year (Preferred)

Work Location: Remote