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. **_***Candidate must reside in the state of AZ***_** **Position Purpose:** Manages the care management team that serves long-term care 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 long-term care management required documentation to maintain compliance with federal and state regulations and contractual agreements + Develops, implements, and oversees long-term care management policies and procedures within the long-term care management team based on regulatory requirements and industry standards + Assigns, monitors and evaluates work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs + Directs the daily activities of long-term care management staff including reviewing and approving the caseloads based on state requirements, care management staff experience, and member needs + Manages escalated and complex care cases, and provides guidance to long-term care team members to address member concerns + Ensure proper coordination and communication of medical service functions with other departmental functions at the business as assigned + Develops, implements, and oversees long-term care management programs to facilitate the use of appropriate services and resources + Sets goals and objectives for long-term care management team to achieve cost-effective healthcare results + Works with long-term care management senior management to provide updates and insights on care management team goals + Reviews long-term care member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations + Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care + Educates and provides resources for long-term care management team on key initiatives and member outreach to facilitate on-going communication between care management team, members, and providers + Assists long-term care management senior leadership with onboarding, hiring, and training long- term care management team members + Performs other duties as assigned + Complies with all policies and standards Education/Experience: Requires a Bachelor's degree and 5+ years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Pay Range: $85,300.00 - $158,100.00 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. 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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Job Tags

Holiday work, Remote job, Flexible hours,

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