[Hiring] Manager, CM (RN) @Centene Corporation

Role Description

Manages the care management team and the care management of members to develop and assess high quality, cost-effective healthcare outcomes. Manages escalations and care management issues related to members or providers.

• Oversees and reviews care management required documentation to maintain compliance with federal and state regulations and contractual agreements.
• Contributes to the development and implementation of policies and procedures within the care management team based on regulatory requirements and industry standards.
• May direct the daily activities of care management staff including reviewing and approving the caseloads based on state requirements, care management staff experience, and member needs.
• Manages processes for escalation and/or complex cases, and provides guidance to team members to address member needs.
• May manage or coordinate resolutions of member escalations and/or complaints and assists in audits and evaluations related to care programs and member concerns.
• Contributes to the development, implementation, and oversight of care management programs to facilitate the use of appropriate services and resources.
• May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources.
• 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 works with senior leadership, as required.
• Monitors audits within care management to ensure compliance with regulatory requirements for federal, state, and National Committee for Quality Assurance (NCQA) standards, as required.
• Provides feedback to care management team to improve member and provider experience and high-quality care.
• Educates and provides resources for care management team on key initiatives and member outreach to facilitate ongoing communication between care management team, members, and providers.
• Assists care management senior leadership with onboarding, hiring, and training care management team members.
• Leads and champions change within scope of responsibility.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Graduate from an Accredited School of Nursing or a Bachelor's degree.
• 5+ years of related experience.
• Prefer UM and CM experience.

Requirements

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required.
• Must be licensed in California.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible approach to work with remote, hybrid, field or office work schedules.