- 1633403
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.
Candidates must reside in Michigan or a surrounding state and be able to accommodate up to 25% field or in-office work.
High Preferred:
Candidates with an active RN license
Candidates with experience with Utilization Management (UM), Care Management (CM) activities, cost of care initiatives, and demonstrated leadership experience.
Position Purpose: Directs the care management team and the care (management) of members to develop and assess high quality, cost-effective healthcare outcomes. Develops strategies and objectives within care management to improve member and/or provider experience.
- Directs and evaluates departmental operations, including the care management model, staffing, use of information technologies, and staff competencies to achieve performance and quality objectives
- Oversees care management team on performance, improvement, and talent management
- 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
- Oversight of the development and implementation of care management policies and procedures within the care management team to ensure compliance with regulatory requirements for federal, state, and National Committee for Quality Assurance (NCQA) standards, as required
- Stays up to date on latest trends and best practices in Payer Care Management and related fields and attends conferences, as required
- Leads process improvements for the care management team to achieve quality and cost-effective healthcare results and working with senior leadership, as required
- Contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care
- Develops care management strategies and influences decisions by providing recommendations that align to organizational objectives
- Develops department budget while collaborating inter-departmentally and with senior leadership
- Develops the overall strategy for onboarding, hiring, and training new care management team members to ensure adequate training and high quality-care to improve member and/or provider experience and ensure compliance
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience: Requires a Bachelor’s degree and 7+ years of related experience, including prior management experience.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
License/Certification:
- Current state’s Registered Nurse (RN) license preferred
Pay Range: $127,300.00 – $236,100.00 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
