Director, Care Management - STAR Kids
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: Directs the long-term care of members to develop and assess high quality, cost-effective healthcare outcomes. Develops strategies and objectives within long-term care management to improve member and/or provider experience.
• Leads long-term care management and care management team on performance, improvement, and career growth path considerations
• Leads long-term care management policies and procedures within the care management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
• Oversees and monitors work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs
• Monitors, reviews, and signs off on contract required reporting as required
• Vendor oversight as required and applicable to the role
• Attends conferences and stays up to date on latest trends and best practices in Payer Care Management and related fields, as applicable
• Leads and presents process improvements for the long-term care management team to achieve cost-effective healthcare results
• Leads and coordinates large or special project work with other departmental functions
• Directs and evaluates departmental operations, including the long-term care management model, staffing, use of information technologies, onboarding, and staff competencies to achieve performance and quality objectives
• Reviews and monitors long-term care member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations, and participates with internal and external audits as required
• Contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care
• Develops long-term care management strategies and influences decisions by providing recommendations that align to organizational objectives
• Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care
• May develop department budget while collaborating inter-departmentally and with senior leadership
• May develop or contribute to developing the overall strategy for onboarding, hiring, and training new long-term 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
Education/Experience: 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.
Strongly Preferred Experience:
• Managerial experience leading start up programs and dynamic teams that focuses on closing health care gaps for patients and families
• Experience managing clinical managers, supervisors, and clinical staff on Behavioral Health LTSS Services
• Strategic Advisor/Consultative, Emotional Intelligence, Communication, Coaching/Training, and Organizational skills are highly critical in this role
• Advanced clinical knowledge and experience assessing children and young adults (up through age 20) with disabilities in context of relevant diagnoses, treatment plans and goals, and identify potential gaps in care or risks of complications is preferred.
• Experience with Medicare, Medicaid or Marketplace insurance practices and regulations is preferred
• Applicants must physically reside in the state of Texas
Pay Range: $131,100.00 - $242,500.00 per year
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.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Apply Now
Apply Now
Position Purpose: Directs the long-term care of members to develop and assess high quality, cost-effective healthcare outcomes. Develops strategies and objectives within long-term care management to improve member and/or provider experience.
• Leads long-term care management and care management team on performance, improvement, and career growth path considerations
• Leads long-term care management policies and procedures within the care management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
• Oversees and monitors work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs
• Monitors, reviews, and signs off on contract required reporting as required
• Vendor oversight as required and applicable to the role
• Attends conferences and stays up to date on latest trends and best practices in Payer Care Management and related fields, as applicable
• Leads and presents process improvements for the long-term care management team to achieve cost-effective healthcare results
• Leads and coordinates large or special project work with other departmental functions
• Directs and evaluates departmental operations, including the long-term care management model, staffing, use of information technologies, onboarding, and staff competencies to achieve performance and quality objectives
• Reviews and monitors long-term care member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations, and participates with internal and external audits as required
• Contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care
• Develops long-term care management strategies and influences decisions by providing recommendations that align to organizational objectives
• Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care
• May develop department budget while collaborating inter-departmentally and with senior leadership
• May develop or contribute to developing the overall strategy for onboarding, hiring, and training new long-term 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
Education/Experience: 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.
Strongly Preferred Experience:
• Managerial experience leading start up programs and dynamic teams that focuses on closing health care gaps for patients and families
• Experience managing clinical managers, supervisors, and clinical staff on Behavioral Health LTSS Services
• Strategic Advisor/Consultative, Emotional Intelligence, Communication, Coaching/Training, and Organizational skills are highly critical in this role
• Advanced clinical knowledge and experience assessing children and young adults (up through age 20) with disabilities in context of relevant diagnoses, treatment plans and goals, and identify potential gaps in care or risks of complications is preferred.
• Experience with Medicare, Medicaid or Marketplace insurance practices and regulations is preferred
• Applicants must physically reside in the state of Texas
Pay Range: $131,100.00 - $242,500.00 per year
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.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Apply Now
Apply Now