Job Description
Serve as a liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams. Assesses and performs review of member clinical records and services related to behavioral health and substance use. Interpret and present program results and develop data-driven analysis and metrics used to measure effectiveness and ROI of all current and new programs. Partner with various staff, along with internal and external departments on provider education and outreach; determine where there are gaps and work to develop and deploy education efforts.
Partner with regional leadership for providers requiring a clinical interpretation of results related to health plan reporting, data and quality incentive payments; facilitate discussions to make recommendations. Implement and manage procedures for tracking, identifying and problem-solving operational issues, including issues between the provider network, community, and the facility, and make recommendations to solve.
About Centene
Centene is committed to helping people live healthier lives by providing access to high-quality healthcare, innovative programs and a wide range of health solutions.