You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.Position Purpose:Perform duties to conduct and manage the day to day operations of the case management functions communicating with departmental and plan administrative staff to facilitate daily department functions.
Review analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes.
Promote compliance with federal and state regulations and contractual agreements.
Develop, implement and maintain compliance with policies and procedures regarding medical case management.
Develop, implement, and maintain case management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure.
Facilitate on-going communication between case management staff, members, contracted providers, and subsidiaries.
Develop staff skills and competencies through training and experience.
Education/Experience: Bachelor’s degree in Nursing or equivalent experience. 3+ years case management experience and recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, or obstetrics and management experience. Thorough knowledge of case and/or utilization management and clinical nursing. Familiarity with Medicaid managed care practices and policies, CHIP, and SCHIP. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.License/Certification: Unrestricted RN license in applicable state(s) and valid driver's license and automobile insurance. Case Management Certification (CCM) preferred.Pay Range: $84,300.00 - $151,700.00 per yearCentene 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.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
