Centene Corp

Lead Care Manager

Centene Corp$87K — $161K *
US-AnywhereRemote in North Carolina, US
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Master's degree in Behavioral Health or Social Work, or Nursing degree from an accredited school
  • 5-7 years of related experience in care management
  • Licensed Master's Behavioral Health Professional (LCSW, LMSW, LMFT, LMHC, LPC) or RN with BH experience
  • Expert knowledge in managing complex care plans, especially in behavioral health
  • Strong understanding of regulatory compliance pertaining to care management

Responsibilities

  • Oversee and review ongoing complex care plans focusing on behavioral health and social needs
  • Perform outreach to assess member needs via various methods including telephonic and site visits
  • Provide guidance on care plan development and triaging complex cases
  • Monitor member status and revise care plans based on treatment complications
  • Collaborate with healthcare providers to ensure effective treatment plans are in place
  • Train care management team and providers on high-quality care delivery
  • Review data to identify health risks and recommend improvements in care delivery

Benefits

  • Health insurance coverage
  • 401K and stock purchase plans
  • Tuition reimbursement for further education
  • Paid time off plus holidays
  • Flexible work arrangements including remote options
Full Job Description

The Lead Care Manager will support the pediatric and maternity care management population, with responsibilities that include managing complex cases, setting up cases, supporting audits, and assisting with the training and onboarding of new team members.

This is a remote position; however, candidates must reside in North Carolina. Approximately 10% travel may be required for occasional meetings or team events in Raleigh or Charlotte. The standard work schedule is Monday through Friday, 8:00 AM to 5:00 PM.

Position Purpose: Oversees the care plans and care management activities of member needs primarily focused on behavioral health needs (including behavioral health, and social needs) to provide quality, cost-effective healthcare. Reviews and provides expert knowledge to inform personalized care plans for the most complex care members and provides guidance and/or support to the care management team.

  • Oversees and reviews ongoing care plans/service plans, which may include which may include behavioral health and social determinant needs and works with care management team to identify providers, specialists, and community resources needed for care
  • May perform telephonic, digital, home and/or other site visits outreach to assess member needs and collaborate with resources
  • Provides insight and guidance on developing care plans and triaging issues to appropriate behavioral healthcare providers for complex care plans/service plans for members with high level acuity
  • Provides guidance and expert knowledge as appropriate to healthcare management team members (including behavioral) to ensure quality control over work, ensure identified services are accessible to members, and adherence to contract policies and procedures
  • Monitors the most complex care plans and/or member status and outcomes for changes in treatment side effects, complications and clinical symptoms and revises care plan/service based on member needs and issues identified including mental health and substance use disorders
  • Provides subject matter expertise insights around mental health and social determinant needs for complex care plans based on prior experience to recommend enhanced member care within the care management plan
  • Reviews member data to identify health risks and/or care gaps, and improve operating performance and quality care to address member’s needs/issues and provides recommendations in accordance with state and federal regulations
  • Partners and collaborates with healthcare providers regarding complex cases as appropriate to facilitate member’s treatments to ensure member treatment requirements are met and determine a revised care plan/service plan for member if needed
  • Collects, documents, and maintains member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
  • Provides training and education to care management team and providers to ensure members are receiving high quality care and information regarding treatment plan options, procedures, referrals, and healthcare benefits including mental health and substance use disorders
  • Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner
  • Monitors management policies and procedures within the care management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
  • Works with senior management on escalated and complex care cases, and provides guidance to junior team members to address member concerns
  • Works as a subject matter expert (SME) and provides training and education to care management team and providers to ensure members are receiving high quality care and information regarding service / care plan options, procedures, referrals, and healthcare benefits, which may include behavioral health and social determinant needs
  • Monitors and review reports on a regular basis ensuring quality and productivity metrics are met and for case assignments, and may perform audits on staff on a regular basis
  • Performs other duties as assigned.
  • Complies with all policies and standards.

Education/Experience: Requires a Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 5 – 7 years of related experience.

License/Certification:

  • Licensed Master's Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN based on state contract requirements with BH experience required

Pay Range: $87,000.00 - $161,300.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

About Centene Corp

Centene Corporation is a managed healthcare enterprise at the forefront of innovation and growth for government-sponsored and commercial healthcare, providing access to fully integrated, high-quality, and cost-effective services that help people lead healthier lives. The company’s local approach addresses the needs of under-insured and uninsured individuals who often lack the resources required to sustain optimal health and wellness. Centene began as a single health plan in Milwaukee, Wisconsin in 1984. After an initial period of growth, Michael Neidorff joined as President and Chief Executive Officer (CEO) in 1996, moving Centene’s headquarters to St. Louis, Missouri, where it still resides today. In the decades since its humble beginnings, Centene has transformed into a publicly-traded Fortune 500 company serving communities across the United States. In fact, Centene provides coverage in all 50 U.S. states. More than 26 million Americans rely on Centene to access a wide range of insurance solutions, including Medicaid, Medicare, TRICARE, correctional, and behavioral health services. Centene prioritizes the development of technology that addresses systemic conditions impacting the whole health needs of underserved populations. As technology plays an increasingly critical role in diagnosing, managing, and treating disease, Centene understands that it enables better health outcomes for members, lessening the burden for providers, and allowing more automation and efficiency for business operations. As a steward of a significant set of data and insights, Centene leverages this data to not only shape but lead the digital transformation of healthcare and improve the patient-provider experience. Centene’s current CEO, Sarah London, and her team are leading the charge in this new age. Sarah London worked within Centene’s Technology Innovation and Modernization division, spearheading the company’s enterprise-wide technology strategy. Now leading Centene, her focus is on building the next generation of products and services and establishing Centene’s long-term growth and value creation. Although Centene has grown into the No. 1 insurer in the U.S. Health Insurance Marketplace, it has never lost its focus on the individual or its passion for community health. Remaining connected to the individuals and families that need care most is central to Centene’s commitment to shaping a better world of healthcare for the communities it serves. Centene also remains connected to the needs of its employees, who make Centene what it is. Through its commitment to diversity, equity, and inclusion practices, Centene promotes a safe and inviting environment above all. Because of Centene’s commitment to excellence and progression in the healthcare industry, it has been recognized as a Top Organization for Diversity by Modern Healthcare magazine, a Leading Disability Employer by the National Organization on Disability, a Best Place to Work for LGBTQ Equality by The Human Rights Campaign Foundation, and a global leader by Bloomberg’s Gender-Equality Index, among many other recognitions. Centene was also named a Top 50 Company for Diversity by DiversityInc and a Top Veteran-Friendly Company by U.S. Veterans Magazine. It has also been listed on FORTUNE® magazine's list of the World's Most Admired Companies for several consecutive years.

Centene Corp Careers

Join the dynamic team at Centene Corp, a leader in the healthcare industry, where your career growth and development are prioritized. At Centene Corp, we offer a range of job opportunities that allow you to make a significant impact on our community and beyond.

Explore a World of Opportunities

Discover the diverse career paths available at Centene Corp, from healthcare services to innovative program development. Our job opportunities span various professional fields, offering positions that cater to your unique skills and ambitions. Whether you're looking for an entry-level role or a senior leadership position, Centene Corp is committed to hiring top talent and fostering a culture of excellence.

Innovation and Leadership at Centene Corp

At Centene Corp, innovation and leadership go hand in hand. We empower our team members to lead with confidence and creativity, driving the company forward through strategic innovation and robust leadership. Our leadership programs are designed to cultivate your skills, helping you to thrive as a professional and make meaningful contributions to our company and the communities we serve.

Internships and Early Career Programs

Kickstart your career with Centene Corp through our internship and early career programs. These opportunities provide hands-on experience and a glimpse into the dynamic world of healthcare management. Internships at Centene Corp are a stepping stone to full-time employment, offering invaluable networking opportunities, mentorship, and the chance to develop your resume and interview skills in a real-world setting.

Commitment to Diversity and Inclusive Culture

Centene Corp is dedicated to maintaining a diverse and inclusive work environment. We believe that diversity fuels innovation and enhances our team's performance. Our diversity training ensures that all team members appreciate and leverage the broad range of experiences and perspectives that each individual brings to the company.

Benefits and Employee Growth

We value our employees' well-being and career aspirations. Centene Corp offers competitive benefits, including health insurance, retirement plans, and professional development programs. Our commitment to your growth is reflected in our continuous learning initiatives and performance management processes that help you achieve your career goals.

Join Our Team

Are you ready to advance your career at Centene Corp? Explore our current job openings and find the position that best matches your skills and interests. We are looking for passionate, curious, and solution-driven team players who are ready to make a difference.

Stay Connected with Centene Careers

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SEARCH CENTENE JOBS

Centene Corp is not just a company—it's a place where you can shape your future and impact the lives of millions. Join us in our mission to transform the health of the community, one person at a time.
Learn more about Centene Corp
Size
72,500 employees
Market Cap
$46.5 billion
Industry
Net Income
$1.8 billion
Founded
1984
5 Year Trend
+25.4%
Revenue
$111.1 billion
NASDAQ

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