1 Lean Six Sigma jobs in East Harlem
Quality Improvement Auditor (Clinical)
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Job Description
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Travel is required within the Albany, Syracuse, Booklyn, the Bronx, Long Island, New York City, Queens, or surrounding areas in the state of New York.
HEDIS experience highly preferred.
Position Purpose:
Lead medical record audits, monitor and analyze clinical documentation, and modify business processes to measure member outcomes. Assess provider performance and quality of care through clinical case reviews.
Lead clinical audits for provider medical records both remotely via electronic medical records and on site to assess performance, determine trends and compile written reports summarizing findings, including clinical recommendations to assure the delivery of quality services
Lead case reviews to assess the clinical performance provided in the provider network, including written clinical summaries and recommendations
Perform ongoing quantitative and statistical analysis of the business unit’s performance data to include various contracted performance measures, service utilization and member/provider complaint and quality of care trends
Coordinate with internal teams to assure audit requests are fully understood, accurately compiled and delivered timely
Perform other performance and process improvement activities
Performs other duties as assigned
Complies with all policies and standards
Licenses/Certifications: Current state’s clinical license (LPN, RN, etc.).Pay Range: $55,100.00 - $99,000.00 per year
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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Director, Process Improvement & Operational Excellence
Posted 2 days ago
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Job Description
**Job Summary**
Leads business process improvement initiatives that result in operational efficiencies and/or an increase in customer satisfaction. Assists in development of MHI's business process improvement methodology and in the implementation of a business process improvement capability.
**Knowledge/Skills/Abilities**
- Defines program scope, establish approach for implementation and maintains program infrastructure
- Develop a method for assessing program effectiveness and a cadence for assessing and adjusting
- Develop approach for communication organizationally about the program
- Determine program support needs
- Gains agreement on process improvement opportunities to be undertaken and assists in the prioritization of approved initiatives/projects.
- Keeps abreast of current trends impacting Lean concepts/methodologies/tools to ensure that best practices are utilized in process improvement efforts.
- Coordinates and collaborates with Molina enterprise Operational Excellence team and health plan Operational Excellence teams
- Ensures appropriate alignment within the program with organizational Operational Excellence programs
- Manages the portfolio of projects, educational programs and coaching plan for the organization
- Develop managers and staff in lean principles, methodology and application through individual coaching, education and projects
- Explains and applies accepted methodologies (i.e. identify desired outcomes, analyze current processes/problems, collect/analyze relevant data, uncover root causes, develop performance/process improvement plan and implementation tactics, test recommendation and assess results.)
- Establish and maintain an education and coaching approach for all levels of staff. Continuously evaluates training and coaching needs of the organization as it relates to process improvement. Develops and maintains the necessary curriculum and supporting materials to education staff and leaders.
- Facilitates Lean improvement workshops in partnership with managers; develops and delivers presentations/education to mentor/coach various key leadership and management staff to promote awareness, understanding, acceptance and engagement of Lean concepts, methodologies and tools.
**Job Qualifications**
**Required Education**
Bachelor's degree required in a related field (Business Administration, Healthcare, Engineering, etc.)
**Required Experience**
- 8 years' experience in healthcare
- 4 years of management level experience
- Understanding of all areas of health plan operations: claims processing, customer service/call center, provider contracting, benefit design and configuration, product development, membership accounting and enrollment, operational systems, provider contracting, authorizations/referrals, utilization management.
- Understands key revenue levers and cost drivers of business processes.
- Understands critical success factors for the industry.
- Experience designing and delivering solutions related to operational improvement functions.
- Strong leadership qualities and ability to get results.
**Preferred Education**
Graduate Degree
**Preferred Experience**
- 6 years of healthcare related process improvement experience with demonstrable successes in application of Lean/Six-Sigma
- 10 years of process improvement experience
**Preferred License, Certification, Association**
LEAN certification and/or Lean Six Sigma Black Belt
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $107,028 - $250,446 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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