Clinical Nurse Liaison

Position is fully remote in Florida, for Sunshine Children's Medical Services, therefore 2 years of pediatric experience is preferred. Occasional travel to office.

In this position you will serve as a liaison to case management for clinical processes and complaint resolution, implement and manage procedures for tracking, identifying and problem-solving member issues and facilitating process improvement.

• Partner with various staff, along with internal and external departments for member complaint resolution.
• Maintains and updates plan job aids ensuring they are current and available to Case Management.
• Assist in preparation and distribution of statewide reporting requirements.
• Analyze data and member records for trends that can improve member and provider satisfaction, member outcomes, and case management processes.

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

Education/Experience:

LPN or LVN license. RN license preferred. 4 years of clinical nursing experience, preferably in a large primary care office or clinic setting working with Medicaid or the uninsured. Experience in conflict management or data reporting and evaluation. Experience working in managed care, utilization management, case management, or quality improvement preferred.

Additional Responsibilities Include:

• Collects, summarizes, and delivers provider quality performance data to strategize/coach on opportunities for provider improvement and gap closure. Educates provider practices on appropriate HEDIS measures, medical record documentation guidelines, and HEDIS ICD-10 CPT coding in accordance with State, Federal, and NCQA requirements.
• Educates, supports, and resolves provider practice sites’ issues around HEDIS, Pharmacy, Member Experience, and Administrative measures.

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.