Centene Corporation Clinical Coordinator (Medicare Case Management) in Clayton, Missouri
Position Purpose: Serve as the subject matter expert for Medicare case management to the health plans to ensure compliance with Model of Care and Medicare regulatory requirements.
- Review case management work process, identify gaps, and develop recommendations and solutions to improve case management processes and outcomes
- Implement a consistent care management infrastructure to promote quality cost effective member outcomes for all Medicare markets through integration of medical, behavioral and social case management initiatives
- Lead and executive standardization of case management processes across all health plans
- Collaborate with health plans to ensure compliance with all CMS clinical operations requirements
- Lead and facilitate restructure of Model of Case and support CMS audit activities, including validation of universe, HRA reporting and other required audit processes
- Develop and maintain case management policies and procedures
- Assist with new product implementations related to case management across the health plans
Education/Experience: Bachelor s degree in Nursing or related field. 4 years of combined clinical and case management experience in a Medicare and/or managed care environment. Knowledge of CMS regulatory standards, National Committee for Quality Assurance (NCQA), quality improvement process and theory strongly preferred.
Licenses/Certifications: Current state s RN license. Certified Case Manager preferred.
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: Health Insurance Operations
Organization: Medical Mgmt Operations
Requisition ID: 1040264