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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.
 

Position Purpose:
Serve as a liaison for external groups and providers regarding clinical information from the Operations and Medical Management teams.

(30 hours per week. May be open to 3 (10) hour days).

  • 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.
  • Performs other duties as assigned
  • Complies with all policies and standards
  • 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.


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.

For Trillium Community Health Plan - Oregon Market:
Education/Experience: LPN or LVN license. RN license preferred. 4+ years of clinical nursing experience 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:

  • Develop, review, validate, update, publish, and present various policies and procedures to ensure alignment with best practices and organizational goals, and compliance with all applicable laws, regulations, and accreditation standards.
  • Researches and submits deliverables to the State and other Organization
  • Minimal travel required (approx 1 - 3 times per year)

Pay Range: $33.03 - $59.47 per hour

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.  Total compensation may also include additional forms of incentives.

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

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Average salary estimate

$96189.5 / YEARLY (est.)
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$68629K
$123750K

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What You Should Know About Clinical Nurse Liaison, Centene

If you're ready to make a real difference in the healthcare field, consider joining Centene as a Clinical Nurse Liaison in Tigard! We're on a mission to transform the way we serve our 28 million members, and we need passionate individuals like you to help us achieve that goal. In this role, you'll be the bridge between clinical and operational teams, providing essential support and guidance. With a flexible work schedule of 30 hours per week, you might even find that three 10-hour days suit you! Your responsibilities will include tracking operational issues, developing data-driven analyses, and collaborating with staff to enhance quality and satisfaction. You’ll also play a key role in educating providers on essential metrics like HEDIS measures and will partner with community initiatives. Your experience as an RN or LPN will be invaluable, especially if you have a background in managed care or Medicaid. At Centene, we pride ourselves on offering competitive benefits, from health insurance to tuition reimbursement, all designed to support your career and personal growth. If you're ready to take the next step and work in an environment that values diversity and innovation, check us out at Centene.

Frequently Asked Questions (FAQs) for Clinical Nurse Liaison Role at Centene
What are the primary responsibilities of a Clinical Nurse Liaison at Centene?

As a Clinical Nurse Liaison at Centene, you will serve as a key point of contact for external groups and providers, sharing important clinical information and addressing operational issues. Your role will involve interpreting program results, developing metrics for effectiveness, and collaborating on process improvements to enhance quality and satisfaction for both staff and members.

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What qualifications are needed to apply for the Clinical Nurse Liaison position at Centene?

To apply for the Clinical Nurse Liaison position at Centene, candidates should possess an LPN or LVN license, with an RN license preferred. Additionally, you should have at least 4 years of clinical nursing experience in a primary care setting, ideally with knowledge of Medicaid and managed care.

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What kind of experience is beneficial for a Clinical Nurse Liaison at Centene?

Experience in managed care, utilization management, case management, or quality improvement is highly beneficial for a Clinical Nurse Liaison at Centene. Familiarity with data reporting, conflict management, and an understanding of HEDIS measures will further enhance your capabilities in this role.

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How does Centene support professional development for Clinical Nurse Liaisons?

Centene supports professional development through a comprehensive benefits package, including tuition reimbursement and opportunities for continued education. The company fosters a culture of growth and innovation, allowing Clinical Nurse Liaisons to advance their careers while making a difference in the community.

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What is the expected pay range for a Clinical Nurse Liaison at Centene?

The pay range for a Clinical Nurse Liaison at Centene is between $33.03 and $59.47 per hour. This range is determined based on individual skills, experience, education, and other job-related factors, ensuring you are compensated fairly for your expertise.

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Common Interview Questions for Clinical Nurse Liaison
Can you describe your experience with clinical data analysis?

In answering this question, highlight specific examples from your previous roles where you analyzed clinical data to improve outcomes. Discuss the tools and methodologies you used, and how your analyses led to actionable improvements in patient care or operational efficiency.

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What strategies do you use to educate providers on HEDIS measures?

Discuss your approach to educating providers on HEDIS measures, which might include creating engaging presentations, one-on-one sessions, or training materials. Emphasize your ability to ensure that providers understand the importance of these measures in relation to quality care.

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How do you handle conflicts in a team environment?

Describe a specific conflict you faced in a team setting and how you approached it. Focus on your communication skills, ability to listen, and how you worked towards a resolution that satisfied all parties involved.

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Why do you want to work for Centene as a Clinical Nurse Liaison?

Express your alignment with Centene's mission to transform health care for its members. Share personal values or experiences that resonate with the company's goals, and discuss how your background makes you a great fit for the team.

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How do you prioritize tasks when managing multiple responsibilities?

Illustrate your organizational skills by discussing a system you use for task prioritization, whether it's based on deadlines, importance, or impact. Provide an example that shows your ability to manage time effectively while ensuring quality outcomes.

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What methods do you employ to build relationships with providers?

Share your techniques for relationship-building, such as regular communication, being responsive to their needs, and providing helpful resources. Emphasize your approach to establishing trust and collaboration with providers.

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Can you give an example of a successful project you led in a clinical setting?

Detail a specific project, your role in it, and the clinical outcomes achieved. Highlight your strategic planning, stakeholder engagement, and any adjustments made along the way to ensure success.

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What is your experience with managed care and its regulations?

Discuss your familiarity with managed care practices and any specific regulations that apply. You might explain how you’ve navigated these regulations in implementing quality care initiatives or compliance processes.

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How do you track the effectiveness of clinical programs?

Explain the metrics and evaluation tools you use to assess clinical program effectiveness. Mention specific examples of data-driven outcomes that were achieved as a result of your tracking efforts and subsequent adjustments.

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What role does teamwork play in your approach to patient care?

Discuss the importance of teamwork in providing comprehensive patient care. Highlight how collaboration with other healthcare professionals improves outcomes and enhances the patient experience.

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Transforming the health of the community, one person at a time.

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Full-time, hybrid
DATE POSTED
April 11, 2025

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