Clinical Nurse Liaison (centene)

Job Description

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.
 

JOB IS FROM: nursingjobs.siteVIEWThis is a hybrid role seeking an LPN or RN that will be a liaison in the Baton Rouge and New Orleans areas doing Provider outreach. 3 days in the field doing visits to facilities and 2 days fully remote doing documentation and outreach. This position drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc. Evaluates provider performance and develops strategic plan to improve performance. Performs detailed HBR analysis. Facilitates provider trainings, orientations, and coaches for performance improvement within the network and assists with claim resolution.

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
• 3 days field; 2 days fully remote administrative

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.

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