Manager, Care Management (RN) - Maternal Child Health at Centene

You're a Registered Nurse with a Bachelor's degree and at least 5 years of care management experience, looking to lead a team focused on maternal child health.

Work type: remote

Location: Remote-DE | Newark-750 Prides Crossing (11131)

Salary: $102,900 – $190,500/yr

Type: Full-time

Summary

You're a Registered Nurse with a Bachelor's degree and at least 5 years of care management experience, looking to lead a team focused on maternal child health. **What makes it worth a look...** Centene is hiring for a fully remote Manager, Care Management (RN) role with a pay range of $102,900.00 to $190,500.00 per year. **You might be a good fit if you...** * Have a Graduate from an Accredited School of Nursing or a Bachelor's degree and 5+ years of related experience. * Hold an RN - Registered Nurse - State Licensure and/or Compact State Licensure. * Possess experience managing care management teams and developing high-quality, cost-effective healthcare outcomes. * Are familiar with federal and state regulations and NCQA standards in a care management setting.

Job Description

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.
 

Position Purpose: 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.

This is a remote role with occasional in office engagement, and attending required meetings with the state.

• 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 on-going 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

License/Certification:

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Centene 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, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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