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Clinical Accounts Manager

Company: Centene Corporation
Location: Redlands
Posted on: October 30, 2019

Job Description:

  • 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 and internal/external customers, including planning, development, implementation and monitoring of population programs for the identified population.

  • Collects, analyzes, interprets, displays and reports clinical programs data of employer groups', internal/external customers -utilization experience.
  • Functions as clinical liaison to internal/external customers, sales team, consultants, employers, and RFP unit.
  • Develops and implements work plans for selected clinical account management internal/external customers and employer groups.
  • Creates presentations regarding clinical programs 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.

    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.

Keywords: Centene Corporation, Redlands , Clinical Accounts Manager, Executive , Redlands, California

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