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.
Must reside in South Carolina. There are weekly meetings on Wednesday in Columbia. There is also a field compenent 25-50% of the role.
Position Purpose: Oversees the care management team and the care management of members to develop and assess high quality, cost-effective healthcare outcomes. Oversees care management teams' facilitation of member and provider needs through the complete care management cycle.
- Provides guidance and directs care management required documentation to maintain compliance with federal and state regulations and contractual agreements
- May review, create, and maintain care management policies and procedures as developed within the care management team and presents to senior leadership team
- Sets goals and objectives for care management team and oversees care management data and reporting metrics to achieve quality and cost-effective healthcare results and working with senior leadership, as required
- Partners with internal and external stakeholders including, members, providers and/or regulators
- Manages and provides guidance on processes for escalation and/or complex cases to team members to address member needs
- Develops strategies and participates in cross functional projects to improve quality of care outcomes and deliver cost savings
- Oversees the implementation of process improvements for the care management team to achieve cost-effective healthcare results and presents to senior leadership team
- Educates and provides resources for care management leaders on key initiatives and member outreach to facilitate on-going communication between care management team, members, and providers
- May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
- May oversee, coordinates, and facilitate the training of care management team members to ensure adequate training and high-quality care to improve member and provider experience
- Supports in developing the overall strategy for onboarding, hiring, and training new care management team members
- Leads and champions change within scope of responsibility
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience: Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 6+ years of related experience, including prior management experience.
License/Certification:
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
South Carolina: Alternate Licensure applicable - RN, LPC, or MSW, LCSW
Pay Range: $98,900.00 - $183,100.00 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.
