Position Purpose: Conduct and manage the daily operations of the case management function
Ensure successful transition of care for members from case management to the utilization management
Review analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes.
Develop, implement and maintain compliance with policies and procedures regarding medical case management
Ensure compliance with federal and state regulations and contractual agreements
Develop, implement, and maintain case management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure
Education/Experience: Bachelor's degree in nursing or equivalent experience. 4+ years of combined clinical nursing and case management experience. 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: RN license, Licensed Clinical Social Worker (LCSW), or Licensed Clinical Professional Counselor (LCPC), valid driver's license and automobile insurance. Case Management Certification (CCM) preferred.
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.