Clinician Specialist

Centene Corporation

Clinician Specialist providing clinical and operational support for utilization management in a national organization. Seeking a candidate with expertise in developing clinical policies and operational efficiency.

Posted 7/21/2026full-timeRemote • Montana, New Mexico • 🇺🇸 United StatesMid-LevelSenior💰 $70,100 - $126,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in developing and implementing clinical policies and guidelines, with a strong focus on operational efficiency and collaboration across teams. Proficient in utilizing MCG clinical guidelines and ensuring compliance with utilization management processes.

Highest-signal resume keywords

Registered NurseDeveloping Clinical PoliciesMCG Clinical GuidelinesExcellent Communication SkillsHighly Organized

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Clinical DocumentationUtilization ManagementPolicy DevelopmentOperational ProcessesWorkflow Evaluation

Soft Skills

Customer Service SkillsMultitaskingCollaboration

Tools & Technologies

MCG CareWeb QI

Certifications & Qualifications

RN LicenseLMSWLCSWLPCMHC

Industry Keywords

Clinical GuidelinesStandard Operating ProcedureBest PracticesDepartment PoliciesOperational Support

About the role

Key responsibilities & impact

Provides clinical and operational support, guidance, and direction to the department related to utilization management and/or case management
Develops, implements, and monitors clinical documentation incorporated into clinical guidelines, policies, and/or procedures
Drafts clinical guidelines in a standardized format to be utilized by department staff that align with departmental policies and procedures
Monitors and organizes the clinical-focused Department Standard Operating Procedure (SOP) and Policy & Procedures
Collaborates with Department leadership and Medical Directors to assist in development or modification of policies & procedures
Oversees the modification or creation of member and provider letters
Collaborates with internal stakeholders to ensure impacted staff are educated on new policies, procedures, and processes
Measures and evaluates effectiveness as it relates to current workflows and processes
Researches and identifies industry best practices to contribute to the development of guidelines, policies, and procedures
Develops and maintains documentation necessary to support consistent, operationally sound processes

Requirements

What you’ll need

Registered Nurse
Experience in Developing Clinical Policies
Technological Savvy
Excellent Communication and Customer Service Skills
Highly Organized with Operational Efficiency
Able to Multitask and Collaborate Effectively Across teams
Understands Interface of UM with Claims and Coding
Self-Starter
MA/MS – Masters Degree preferred
3-5 years related experience required
Experience with MCG clinical guidelines required
Prior experience with MCG CareWeb QI guideline modification module preferred
RN, LMSW, LCSW, LPC, or MHC License required

Benefits

Comp & perks

competitive pay
health insurance
401K and stock purchase plans
tuition reimbursement
paid time off plus holidays
flexible approach to work with remote, hybrid, field or office work schedules