Director, Clinical Outcomes Analysis

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Direct the development of analytical processes and data interventions to improve quality performance and identify clinical opportunities and target membership for specific quality and clinical interventions.

• Establish and monitor roadmaps to investigate high cost and low quality providers and develop actions plans to lower cost and improve quality.
• Perform analysis of financial, healthcare cost and utilization, and quality measures data.
• Participate in trend analysis and various committees.
• Participate in Integrated Care Team rounds and provide data analytics insight on clinical opportunities.
• Work closely with Finance leadership to analyze rising cost and utilization trends.
• Develop and monitor annual operating plan initiatives to lower utilization cost and improve quality.
• Develop data validation process to ensure accurate HEDIS and state specific measures reporting.
• Serves as key leader in monitoring operational performance metrics, collaborating closely with analytics and workforce management teams to align clinical operations with strategic organizational goals.

Education/Experience: Bachelor's degree in Healthcare Analytics, Math, Statistics or related field. 5+ years’ experience involving plan operation and clinical programs. Previous experience as a lead in a functional area, experience including hiring, training, assigning work and managing the performance of staff. Experience with utilization management metrics and profiling is preferred.

Pay Range: $145,100.00 - $268,800.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act