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Clinical Nurse Liaison
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | North Charleston, SC North Charleston, South Carolina |
About this job
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 atrisk targets
50% travel required
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.
HIGHLY PREFERRED:
* RN
* HEDIS experience
* Medical Records Review experience
* Medical Auditing experience
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.
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 atrisk targets
50% travel required
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.
HIGHLY PREFERRED:
* RN
* HEDIS experience
* Medical Records Review experience
* Medical Auditing experience
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.