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Manager, Case Management (Long Term Care)

Carolina Complete Health Charlotte, North Carolina

As a member of the Centene Medical Management/Health Services team, you’ll help innovate and execute strategies that redefine the industry standard for improving the lives and health of people. We’re a team of skilled physicians, nurses, pharmacists, social workers and health service experts who use our advanced clinical analytics to implement award winning programs, develop care, deliver partnerships, and work directly with our members to achieve outcomes that set us apart as industry leaders. Together, we’re transforming the health of communities, one person at a time.

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What does it take?

What are the qualities that will help you achieve success in this role at Centene?

Success Profile

  • Detail-oriented
  • Trustworthy
  • Personable
  • Quick-thinking
  • Multi-tasker
  • Good listener

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“Centene is an exciting company to work for, the pace at which we’re growing allows numerous advancement opportunities. Also, we foster an environment that supports and offers numerous leadership growth opportunities.”

- Esmeralda Baig, SVP Operations, Complex Care Products

“I enjoy the people and the flexibility of my role. As an onsite nurse, I have the pleasure of working with my team at Centene as well as the wonderful team at my onsite hospital.”

- Njeri Young, RN, Concurrent Review Nurse

“I assisted with one of the Provider fairs in the community. Seeing how much we care for our community and our patients was very eye opening.”

- Julie Boulch, Senior Manager of Medical Management Operations

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Job ID 1144518

Category Clinical & Nursing
Schedule Full-time
Position Purpose: Perform duties to conduct and manage the day-to-day operations of the case management functions communicating with departmental and plan administrative staff to facilitate daily department functions.

  • Oversee the workflow and day-to-day operations of the case management function
  • Review analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes for case management
  • Ensure compliance with federal and state regulations and contractual agreements
  • Develop, implement and maintain compliance with policies and procedures regarding medical and social case management
  • Develop, implement, and maintain case management programs to facilitate the use of appropriate medical and community resources and decrease health plan financial exposure
  • Ensure proper coordination and communication of medical service functions with other departmental functions at the business as assigned.
  • Assist with provision of Medicare coverage and services
  • Qualifications:

    Education/Experience: Bachelor’s degree in Nursing, Social Work or equivalent experience. 3+ years of case management experience. Thorough knowledge of utilization management. Familiarity with Medicaid and Medicare managed care practices and policies, Children’s Health Insurance Program (CHIP), and State Children's Health Insurance Program (SCHIP). Supervisory or lead experience preferred.

    License/Certification: Current state 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.
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    Our Medical Roles

    Overall Medical Management

    A member of the Centene Medical Management team, we innovate and execute strategies that redefine the industry standard for improving the lives and health of people.

    Concurrent Review Nurse

    To ensure our members get the best quality of care, you’ll assess acute member health conditions, treatment and intervention options, and match them with providers, community and health plan resources.

    Prior Authorization Nurse

    You’ll ensure our members get the best quality services, assistive devices, and equipment to promote optimal health and independence in the community and help promote health and independence.

    Care Manager

    Working directly with members, interdisciplinary care team, providers and data analytics, you’ll identify member health risks and conditions and intervention and service options.

    LTSS Program Specialist/Program Specialist Field Based

    Working directly with our most vulnerable members, you’ll identify individual member health risks and opportunities to enhance independence, quality of life and community engagement.

    Referral Specialist

    You’ll use our data systems to directly assist providers, requesting services and treatments for our members.

    Medical Director

    To help support the individual needs of members and develop programs that address issues, you’ll review population health data, help design clinical programs, and develop care delivery partnerships.

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    Our Awards

    Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.

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    Our Hiring Process

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    “Flexibility is key. Centene is a company of change.”

    Ashley Collier

    Started as a Referral Specialist, now a Project Manager IV

    See Ashley's career path

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