Clinical Improvement Specialist
Posted 2025-08-15
Remote, USA
Full Time
Immediate Start
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. Apply tot his job
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. Apply tot his job