Full-Time

Manager – Care Management

RN

Confirmed live in the last 24 hours

Centene

Centene

10,001+ employees

Provides health insurance and services

Healthcare

Compensation Overview

$100.9k - $186.8kAnnually

Senior

Columbia, SC, USA

Must reside in South Carolina and travel to Columbia, SC office one day per week.

Category
Nursing & Allied Health Professionals
Medical, Clinical & Veterinary
Requirements
  • RN license (SC) required
  • BSN strongly preferred
  • Graduate from an Accredited School of Nursing or a Bachelor's degree
  • 5+ years of related experience
Responsibilities
  • Manages the care management team and the care management of members to develop and assess high quality, cost-effective healthcare outcomes
  • 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
Desired Qualifications
  • BSN strongly preferred

Centene Corporation operates in the healthcare industry, focusing on providing health insurance and services to individuals, particularly those who are underinsured or uninsured. The company offers a variety of health insurance products, including medical, dental, vision, and behavioral health services, as well as pharmacy benefits. Centene's business model emphasizes a localized approach, allowing it to tailor its services to meet the specific needs of different communities across the United States. This strategy sets Centene apart from competitors by ensuring that care is relevant and accessible to its members. The company generates revenue primarily through premiums collected from its 27.5 million members, amounting to $140.1 billion in 2023. Centene's goal is to improve health outcomes while managing costs, and it is committed to corporate sustainability, addressing social barriers to health, and supporting employee well-being through flexible work arrangements.

Company Stage

IPO

Total Funding

N/A

Headquarters

Saint-Louis, Senegal

Founded

1984

Simplify Jobs

Simplify's Take

What believers are saying

  • Expansion of telehealth services enhances access for underserved populations.
  • ICHRA introduction attracts customers seeking personalized, flexible insurance options.
  • Essential Plan expansion highlights growth potential in low-cost insurance markets.

What critics are saying

  • Increased competition in the Health Insurance Marketplace may impact Centene's market share.
  • Potential regulatory changes in Medicaid and Medicare could affect revenue streams.
  • Economic downturns may decrease premium collections, impacting financial performance.

What makes Centene unique

  • Centene's localized approach tailors healthcare services to specific community needs.
  • The company offers a wide range of health insurance products through local brands.
  • Centene focuses on cost-effective, high-quality care for underinsured and uninsured individuals.

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Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Vacation

Hybrid Work Options

Flexible Work Hours