Manager, Care Management

Company: Carolina Complete Health
Location: Wilmington
Posted on: January 25, 2023

Job Description:

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Perform duties to conduct and manage the day to day operations of the care management functions communicating with departmental and plan administrative staff to facilitate daily department functions.--- Manage the delivery of services to members, ensuring services are appropriate and cost effective.
--- Ensure compliance with government and company requirements in the care management department. Develop and implement new procedures, regulatory filings and manage compliance issues.
--- Develop, implement, and oversee care management policies and procedures and give specific guidance to staff and departments as appropriate.
--- Develop, implement, and maintain care management programs to facilitate the use of appropriate services and resources in order to maintain the member in the least restrictive environment.
--- Direct the daily activities of care management staff. Facilitate on-going communication between case management staff, members, contracted providers, and subsidiaries.
--- Develop staff skills and competencies through training and experience.
--- Manage resolution of complaints, and assist in audits and evaluations related to the Long Term Care Program. If necessary, develop and implement corrective action plans.Education/Experience: Bachelor's degree in Social Work, Sociology, Psychology, Nursing, Gerontology, related field or LPN/RN. 6+ of long term care related experience. Thorough knowledge of case and/or utilization management. Familiarity with Medicaid managed care practices and policies, CHIP, and SCHIP. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.License/Certification: Valid driver's license.For North Carolina plan: LCSW, RN, LPC, LMFT, or Psychologist in good standing--- Must reside in North Carolina--- If serving members with BH conditions, must: o Be a master's-level fully Licensed Clinical Social Worker (LCSW), fully Licensed Clinical Mental Health Counselor (LCMHC), fully Licensed Psychological Associate (LPA), fully Licensed Marriage and Family Therapist (LMFT) or licensure as a Registered Nurse (RN)--- Have three (3) years of experience providing care management, case management, or care coordination to the population being served Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.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.

Keywords: Carolina Complete Health, Wilmington , Manager, Care Management, Executive , Wilmington, North Carolina