Director, Care Management - LTSS

Centene Corporation•Remote-IL, IL

12d•$127,300 - $236,100

About The Position

The Director, Care Management - LTSS directs long-term care for members to develop and assess high-quality, cost-effective healthcare outcomes. The role develops strategies and objectives within long-term care management to improve member and provider experience. This leader oversees Illinois care management operations, with particular emphasis on LTSS and Waiver programs, and leads the team’s performance, improvement, and career growth. Applicants must reside in Illinois or be open to relocating; the posting also states that candidates must reside in Illinois. The director oversees care management policies, procedures, staffing, caseloads, reporting, vendor relationships, projects, and departmental operations. The role monitors member data and performance, supports audits and regulatory compliance, contributes to clinical care pathways, and coaches the team to deliver high-quality care. Depending on organizational needs, the position may contribute to budget development and onboarding, hiring, and training strategies. For the Illinois Health Plan, the director also serves as an internal consumer advocate for MLTSS enrollees. The role requires a bachelor's degree and at least seven years of related experience, including prior management experience, or equivalent experience. Managed care experience is strongly preferred. The stated annual pay range is $127,300 to $236,100. Centene describes its work as supporting individuals, families, and communities in accessing effective healthcare. Its listed benefits include competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off and holidays, and flexible work arrangements that may be remote, hybrid, field, or office-based. Benefits may be subject to eligibility; pay and total compensation may vary based on job-related factors and may include incentives.

Requirements

Bachelor's degree, or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope, and skill reflective of the position level.
At least 7 years of related experience, including prior management experience.
Applicants must reside in Illinois or be open to relocating; the posting also says candidates must reside in Illinois.
Comfort presenting to leadership, analyzing data, and driving performance outcomes.

Nice To Haves

Managed care experience is strongly preferred.
Deep expertise in LTSS and Waiver programs.

Responsibilities

Lead long-term care management and the care management team in performance, improvement, and career growth considerations.
Lead long-term care management policies and procedures to ensure compliance with corporate, state, and NCQA standards.
Oversee and monitor staff work assignments and caseloads based on state requirements, staff experience, and member needs.
Monitor, review, and sign off on contract-required reporting as required.
Provide vendor oversight as applicable to the role.
Attend conferences and stay current on trends and best practices in payer care management and related fields, as applicable.
Lead and present process improvements to achieve cost-effective healthcare results.
Lead and coordinate large or special projects with other departmental functions.
Direct and evaluate departmental operations, including the long-term care management model, staffing, information technology use, onboarding, and staff competencies, to achieve performance and quality objectives.
Review and monitor long-term care member data to identify trends and improve operating performance and quality of care in accordance with state and federal regulations; participate in internal and external audits as required.
Contribute to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care.
Develop long-term care management strategies and influence decisions with recommendations aligned to organizational objectives.
Coach and guide the long-term care management team to improve member and provider experience and facilitate high-quality care.
May develop the department budget in collaboration with other departments and senior leadership.
May develop or contribute to strategies for onboarding, hiring, and training new team members to ensure adequate training, high-quality care, and compliance.
For the Illinois Health Plan, serve as a consumer advocate for MLTSS enrollees, including ensuring their interests are considered in policy development, planning, decision making, and oversight.
Perform other duties as assigned.
Comply with all policies and standards.