Centene Corporation Manager, Care Management in Rancho Cordova, California
ProfessionalPosition Purpose: Under the direction of the Director of Care Management, the Manager of Care Management is responsible for region activities related to process improvement and project implementation of care management programs. A strong focus is placed on state level development, implementation and monitoring of outcomes for Care Management Programs in accordance with corporate policy and procedures.Works with Director of Care Management and Senior Medical Director to develop and implement short term/long term Care Management programs geared toward specific state situs based populations.Works with vendors, providers in program implementation and monitoring of health outcomes.Participates in planning, implementing and assessing state and corporate programs designed to proactively identify members who are at risk and in need of care management services.Implements processes to assure members are enrolled in the appropriate programs.Uses utilization data as well as outcome data to measure a program’s effectiveness.In collaboration with and Care Management, monitors the effectiveness of state implemented care management programs on health outcomes. Assesses and revises state level Care Management programs to optimize health outcomes.Works in collaboration with the Care Management Director to identify areas of opportunity and/or provider education.Maintains Care Management vendor relationships on a daily and aggregate basis to ensure the care given to our members is appropriate and compliant with policy and governmental regulatory requirements.Communicates with providers, members and community resources, as necessary, to support the planning, implementation and evaluation of care management programs.Participates in corporate and state regulatory activities. Performs audit activities as required, and participates in establishment of corrective action as necessary.Education/Experience: Bachelor’s Degree in Nursing, Health Care Services, or other health related field.Previous experience in an HMO insurance or medical setting is highly desirable.Experience in Disease Management or Case Management program development and implementation required.Five years clinical experience, minimum three years supervisory experience, preferably with HMO experience in a medical management capacity.Project management experience is highly desirable.License/Certification: Must have and maintain current, valid and unrestricted professional licensure, CCMGovernment Security/Clearance/Citizenship Requirements: This position requires US Citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security
TITLE: Manager, Care Management
LOCATION: Rancho Cordova, California
COMPANY: Health Insurance Operations
POSITION TYPE: Professional
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.