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. 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. Key Responsibilities: 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, 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. Stays up to date on the 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, 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: $116,800.00 - $216,200.00 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. #J-18808-Ljbffr Centene Corporation
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