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