WellCare

Process Improvement Specialist -Provider Data

Posted on: 16 Feb 2021

Austin, TX

Job Description

YOU can be the one who changes EVERYTHING!
At Centene, your innovative thinking and new ideas can help us change the world of healthcare and transform our communities. When you join us, you'll become part of a team that helps run health plans in states coast-to-coast. Here, your skills, your passion and your vision can make a difference every day.
If you're ready for a career built around helping others, this will be your purpose at work.



Position Purpose:

As a Process Improvement Specialist, you are responsible for managing and analyzing data concerning our Providers to ensure continuous improvement. You will also be making recommendations for additional improvments.



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* Deep dives into large data sets. Strategic & Financial Planning, Audits & Reconciliation, SQL Queries & Reporting, Business Performance Improvement, Data Identification & KPI Reporting, Financial Analysis & Reporting, Creating, implementing, and supporting Executive-level strategic goals. Auditing, Financial variances and updated gap analysis documentation.
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* Identify and implement enterprise wide process improvement activities utilizing LEAN/Six Sigma, Plan-Do-Study-Act (PDSA) or similar methodologies to support business infrastructure and procurement of new business opportunities
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* Support the development, prioritization and execution of performance improvement projects utilizing LEAN/Six Sigma, PDSA or similar methodologies for all process improvements Assist with the implementation and training of functional areas regarding process engineering maintenance plans and staff trainings to improve effectiveness Collect, monitor and evaluate project key performance metrics and develop project status reports Facilitate cross functional improvement teams following DMAIC (Define, Measure, Analyze Improve Control) roadmap or similar improvement process Communicate gaps in process designs and implementations to upper management



Highly qualified individuals will the following:



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* Experience with the following- Business Process, Data Analysis, Process Analysis, Process Improvement
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* Experience with SQL, Python, C++, Teradata, Expert level Excel



Education/Experience:

Bachelor's degree in related field or equivalent experience. 4+ years of LEAN, Six Sigma or similar process improvement experience within the healthcare industry preferred. Previous working knowledge of process mapping and design, statistical applications and project management software.

Licenses/Certifications: LEAN/Six Sigma Green Belt. Black Belt preferred

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.

WellCare

Tampa, FL

WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.

The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.

The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.