Clinical Improvement Specialist - CenCal Health : Job Details

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.

• We're looking for an RN who enjoys visiting local providers/clinics to improve the quality of care for our members. The ideal candidate will have 2+ years of experience in the healthcare field, with outpatient care experience considered a plus. Do you understand clinical issues and medical diagnoses? Have you performed chart audits? If so, we have an opportunity for you!

This role requires being in the office one day per month in Santa Barbara.

Strong team-oriented skills to connect with quality improvement staff, and the ability to establish and maintain positive professional 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 and long-term projects.

Ability to evaluate data, establish facts, and draw valid conclusions.

Effective oral and written communication skills.

Experience with HEDIS medical record data abstraction is preferred.

Bachelor's Degree in a healthcare-related field.

At least 2 years of experience in a managed care quality management setting, or a combination of academic, professional, or work experience demonstrating the ability to perform the duties of the position.

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

Desired qualifications include a graduate degree in healthcare or management (e.g., MBA, MPH), and certification as a Professional in Healthcare Quality (CPHQ) or similar.

Experience with HEDIS medical record data abstraction is a plus.

An emphasis in Medicaid/Medi-Cal managed care is preferred.

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

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