Supervisor, Clinical Operations

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.
 

Candidate must reside in AZ. Prefer candidate to live in/around Phoenix. AZ RN Licensure and/or Compact State Licensure required. Experience in clinical appeals or utilization management processes strongly preferred.

Position Purpose: Supervises and supports the implementation of clinical initiatives and/or programs to enhance care coordination, operational efficiency, and quality outcomes. Oversees daily clinical operations and staff to ensure processes are executed consistently in alignment with NCQA standards, state regulations, and applicable contractual requirements.

• Oversees and supports the execution and review of clinical initiatives and/or programs to improve care coordination, efficiency, and quality outcomes.
• Coordinates and supports clinical, quality, documentation, and data submission activities to support operational and quality objectives.
• Reviews utilization, outcome, safety, and cost data and escalates identified trends or concerns to leadership for further action.
• Supports the implementation and monitoring of established clinical plans, policies, and procedures to improve processes and health and quality outcomes, based on available data.
• Provides guidance to the clinical operations team on established clinical processes and initiatives and escalates opportunities for improvement as appropriate.
• Reviews assigned reports and data summaries to support leadership monitoring of initiatives and programs, and provides operational input on opportunities to support member experience, quality, and cost efficiency.
• Partners with leadership to support alignment of clinical initiatives and/or programs with NCQA standards, state mandates, and applicable contractual requirements.
• Provides feedback to clinical operations leadership on clinical initiatives and/or programs to support improvements in processes, care coordination, efficiency, and quality outcomes.
• Supports onboarding, training, and hiring activities for clinical operations team
• Monitors individual and team performance metrics, identifies performance gaps, and provides coaching or escalates concerns to leadership as appropriate to support operational and quality goals.
• Identifies operational, clinical, or compliance risks within assigned work and escalates issues to leadership with supporting information and recommended next steps.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience: Requires a Bachelor's degree and 4+ years of related experience.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
License/Certification:

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Candidate must reside in AZ. Prefer candidate to live in/around Phoenix. AZ RN Licensure and/or Compact State Licensure required. Experience in clinical appeals or utilization management processes strongly preferred.

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.

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