Clinical Nurse Liaison

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. This 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