Manager - Care Management, RN

March 28

🏖️ New Jersey – Remote

Although this job is listed in New Jersey, this company may be open to hiring remote in other states.

💵 $100.9k - $186.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Centene Corporation

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Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

Contracting • Network Development • Managed Care

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

📋 Description

• Manages the care management team and the care management of 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 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.

🎯 Requirements

• Graduate from an Accredited School or Nursing or a Bachelor's degree and 5+ years of related experience. • RN - Registered Nurse - State Licensure and/or Compact State Licensure required

🏖️ Benefits

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules