Clinician Specialist

Centene Corporation

. Provide clinical and operational support, guidance, and direction related to utilization management and/or case management .

Posted 9/15/2026full-timeRemote • Oklahoma • United StatesMid-LevelSenior💰 $70,100 - $126,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management processes and regulatory compliance, with strong project management and organizational skills to effectively develop and implement clinical guidelines and policies. Proficient in data analysis and reporting to assess department performance and communicate progress.

Highest-signal resume keywords

Utilization ManagementMCG Clinical GuidelinesData AnalysisProject ManagementRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical DocumentationSOP DevelopmentPolicy DevelopmentWorkflow EvaluationRegulatory Updates

Soft Skills

Strong CommunicationStakeholder EngagementOrganizational Skills

Tools & Technologies

Reporting ToolsPrior Authorization ToolsMCG CareWeb QI

Certifications & Qualifications

Active RN LicenseLMSW LicenseLCSW LicenseLPC LicenseMHC License

Industry Keywords

Clinical GuidelinesOperational SupportCase ManagementDepartment SOPsRegulatory Compliance Requirements

About the role

Key responsibilities & impact

Provide clinical and operational support, guidance, and direction related to utilization management and/or case management
Develop, implement, and monitor clinical documentation incorporated into clinical guidelines, policies, and procedures
Draft standardized clinical guidelines aligned with departmental policies and procedures
Draft new clinical criteria and review and update existing criteria for compliance with state and federal guidelines
Monitor and organize clinical-focused department SOPs and policies and procedures
Create new SOPs as needed to facilitate regulatory compliance
Collaborate with department leadership and Medical Directors on policy and procedure development or modification
Oversee modification or creation of member and provider letters, determination notices, and other regulatory notices
Coordinate with internal stakeholders to educate impacted staff on new policies, procedures, and processes
Measure and evaluate workflow and process effectiveness, identify gaps, and improve performance
Research industry best practices and published information to support guideline, policy, and procedure development
Develop and maintain tip sheets, SOPs, audit tools, and other operational documentation
Obtain data and run basic reports to assess department performance
Summarize data and create basic presentations to communicate progress to management
Collaborate with trainers and supervisory staff on implementations and rollout of new policies and procedures
Review regulatory updates and participate in department projects

Requirements

What you’ll need

Strong project management and organizational skills, with the ability to manage multiple priorities and meet regulatory deadlines
In-depth knowledge of Utilization Management processes, prior authorization tools, and regulatory compliance requirements
Strong communication and stakeholder engagement skills
Proficiency in data analysis, reporting tools, and software used to track and communicate regulatory and operational information
Ability to work independently with minimal direction while navigating ambiguity and changing priorities
An active RN license
Candidates must reside in Oklahoma
3-5 years related experience required
MA/MS – Masters Degree preferred
Experience with MCG clinical guidelines required for Clinical Specialist position in Medical Management
Prior experience with MCG CareWeb QI guideline modification module preferred
RN, LMSW, LCSW, LPC, or MHC License required
Licensure as RN required for Clinical Specialist position in Medical Management
Standard schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m.

Benefits

Comp & perks

Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation
Diversity-focused equal opportunity employer