Job Description

Position Purpose:




* Responsible for providing oversight of the Care Management team and coordination of necessary resources for members. This may include adequate clinical, behavioral, acute/chronic, and social care services.

* Ensure staff is able to facilitate member and provider needs through entire care management cycle.

* Manage coordination of care challenges experienced by all members of different lines of business.

* Oversee clinical practice coaching activities to enhance service delivery for individual members, including clinical practice coaching at provider agencies through Provider Clinical Practice Coaches.

* Identify opportunities for cost savings and improved member outcomes for members shared with other payers.

* Promote integration of physical and behavioral health practices.

* Manage the coordination of care and transition of care activities for individual members and their families to achieve and maintain performance standards that meet or exceed contract requirements and established target for quality and customer service.

* Partner with internal staff on key initiatives and outreach for members as needed.

* Implement policies and procedures through oversight for complex cases and present to management.

* Coordinate the training of care management staff.

* Facilitate on-going communication between care management staff and providers

* Oversee care management caseloads and create reports to regulate compliance with federal and state regulations and contractual agreements.

* Evaluate complex data to manage the integrated care program and develop, prepare, and present reports on the program and issues to both internal and external stakeholders.

* Manage the daily activities of supervisory staff to promote quality improvement and efficient methods.



Education/Experience:



Bachelor's degree in Nursing, Social Work, Health Care Administration, related field or equivalent experience. 5+ years of social work, healthcare administration, patient/community advocacy, care management, or combined care management and clinical nursing experience. 2+ years of supervisory experience in a related field.

Licenses/Certifications:



For North Carolina plan: Licensed LCSW or licensed RN in good standing. Must reside in North Carolina.



Licensed Clinical Social Worker (LCSW), Licensed Marriage & Family Therapist (LMFT), Licensed Behavioral Health Medical Practitioner, Licensed Professional Counselor, Licensed Substance Abuse Counselor, Licensed Psychologist, or Registered Nurse preferred.

For North Carolina plan LTSS: Experience to include 2+ years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience.



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.