Director, Care Management - LTSS

Centene Corporation•Remote-PA, PA

4d•$127,300 - $236,100•Hybrid

About The Position

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. Pennsylvania resident highly preferred. Up to 25% travel across PA and occasional reporting to a PA office. Position Purpose: Directs the long-term care of members to develop and assess high quality, cost-effective healthcare outcomes. Develops strategies and objectives within long-term care management to improve member and/or provider experience.

Requirements

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.

Nice To Haves

Pennsylvania resident highly preferred.

Responsibilities

Leads long-term care management and care management team on performance, improvement, and career growth path considerations
Leads long-term care management policies and procedures within the care management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
Oversees and monitors work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs
Monitors, reviews, and signs off on contract required reporting as required
Vendor oversight as required and applicable to the role
Attends conferences and stays up to date on latest trends and best practices in Payer Care Management and related fields, as applicable
Leads and presents process improvements for the long-term care management team to achieve cost-effective healthcare results
Leads and coordinates large or special project work with other departmental functions
Directs and evaluates departmental operations, including the long-term care management model, staffing, use of information technologies, onboarding, and staff competencies to achieve performance and quality objectives
Reviews and monitors long-term care member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations, and participates with internal and external audits as required
Contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care
Develops long-term care management strategies and influences decisions by providing recommendations that align to organizational objectives
Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care
May develop department budget while collaborating inter-departmentally and with senior leadership
May develop or contribute to developing the overall strategy for onboarding, hiring, and training new long-term 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.