Manager, Care Management (RN)

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time.

As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Candidates need to reside in one of the 5 boroughs, Westchester, Nassau or Suffolk.

Position Purpose : Manages the LTSS Nurses team to develop and assess high quality, cost-effective healthcare outcomes. Manages escalations and intake issues related to members or providers.

• Oversees and reviews intake 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 Intake team based on regulatory requirements and industry standards
• May direct the daily activities of Intake staff including reviewing and approving the caseloads based on state requirements, Intake 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 intake 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 Intake team and oversees intake data and reporting metrics to achieve quality and cost-effective healthcare results and works with senior leadership, as required
• Monitors audits within Intake to ensure compliance with regulatory requirements for federal, state, and National Committee for Quality Assurance (NCQA) standards, as required
• Provides feedback to intake team to improve member and provider experience and high-quality care
• Educates and provides resources for intake team on key initiatives and member outreach to facilitate on-going communication between intake team, members, and providers
• Assists intake senior leadership with onboarding, hiring, and training intake team members
• Leads and champions change within scope of responsibility
• Performs other duties as assigned
• Complies with all policies and standards

Education / Experience : Requires Graduate from an Accredited School or Nursing or a Bachelor's degree and 5+ years of related experience. Master's degree preferred.

License / Certification :

RN - Registered Nurse - State Licensure and / or Compact State Licensure required

Pay Range : $98,900.00 - $183,100.00 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.

Total compensation may also include additional forms of incentives.