Clinical Improvement Specialist

Company Description

CenCal Health is a publicly-funded managed care organization that provides health care coverage for residents in Santa Barbara and San Luis Obispo counties. We are currently seeking a Claims Customer Service Supervisor in our Santa Barbara office location.  

Job Description

• We're looking for a RN that likes to make visits to local providers/clinics to upgrade our quality of care for our members.  Need to have 2+ years experience in healthcare field, outpatient care a plus.  Are you good at understanding clinical issues and medical diagnosis?  Performed chart audits?  We've got an opportunity for you!

Qualifications

This role has a requirement of being in office 1 day per month in Santa Barbara

• Strong team-oriented ability to
  connect with quality improvement staff, and establish and maintain positive
  professional working relationships, both within and outside CenCal Health

• Knowledge of quality improvement
  theory, strategy, and practical methods to achieve rapid-cycle improvement;

• Ability to perform effectively under
  pressure and maintain focus on daily responsibilities for long-term projects; 

• Ability to establish and nurture
  positive professional working relationships with CenCal Health customers;

• Ability to evaluate data,
  establish facts and draw valid conclusions;

• Effective oral and written
  communication skills;

• Ability to perform HEDIS medical

Education and Experience

• Bachelor’s Degree in ajob-related field

• 2 years’ experience in a managed care quality management setting (or combination of academic, professional or work experience that demonstrates ability to perform the duties of the position.

• Current and unrestricted Registered Nurse (RN) license to practice in California

DESIRED:

• A graduate degree in a
  healthcare- or management-related discipline is preferred (e.g., MBA, MPH)

• Certified Professional in
  Healthcare Quality (CPHQ) or similar certification

• HEDIS medical record data abstraction

An emphasis in Medicaid/Medi-Cal managed care

Salary Range: $78,562 - $121,771

 

Additional Information

To view our current job openings, please visit our website at www.cencalhealh.org.