Director, Care Management

Centene Corporation

10d•Hybrid

About The Position

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.

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.
Candidates must reside in Michigan or a surrounding state and be able to accommodate up to 25% field or in-office work.

Nice To Haves

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.

Responsibilities

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.