Clinical Accounts Manager
Company: Centene Corporation
Location: El Segundo
Posted on: November 20, 2019
- 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
- Collects, analyzes, interprets, displays and reports clinical
programs data of employer groups', internal/external customers
- 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
- 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
- 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
- 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
- Participates in departmental evaluation, audit and improvement
- 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
- 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
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, Orange , Clinical Accounts Manager, Executive , El Segundo, California
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