Senior Director, Case Management
Posted on: 2 Feb 2021
Lenexa, KS
Job Description
Position Purpose:
Oversee case management operations for the health plan. Define and direct the case management program for the plan in conjunction with corporate goals and objectives.
* Lead and direct the overall operation of the case management function to ensure consistency of policies, procedures and work flows
* Ensure member and provider satisfaction with case management program
* Evaluate case management program effectiveness and recommend improvements
* Ensure case management targets for all products are met for the annual operating plan, state requirements and financial management
* Ensure that utilization management process is integrated with case management program
* Maintain compliance with National Committee for Quality Assurance (NCQA) standards for case management function.
* Identify quality and risk management issues and facilitate the collection of information for quality improvement and reporting
* Review various reports and identify trends to assist in financial forecasting
Education/Experience:
Bachelor's degree in Nursing, related field, or equivalent experience. 7+ years of nursing experience in an acute care setting or complex case management experience. Experience in managed care environment.
License/Certification:
RN license.
For Florida plan only: RN, LCSW, LCMHC or other Clinical Mental Health Professional license required.
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.title:Senior Director, Case Management
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
-
IndustryHealthcare
-
No. of Employees12, 000
-
Website
-
Jobs Posted917
