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Senior Director, Medical Management

Michigan Health Plan Troy, Michigan

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 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, Director, Business Implementation Health Plan Initiatives

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Job ID 1153879

Category Clinical & Nursing
Schedule Full-time

Position Purpose: Direct medical management program including utilization management, case management, and quality improvement in accordance with the mission, philosophy, and objectives of the plan and in conjunction with Corporate goals and objectives.

  • Develop department objectives and organize activities to achieve objectives.
  • Evaluate and implement changes to medical service functions and performance in relation to company mission, philosophy objectives and policies for multiple health plans.
  • Participate as a subject matter expert in implementation of new health plans.
  • Manage budget and forecast for strategic planning and key initiatives.
  • Coordinate with operating departments on research and implementation of best practices.
  • Responsible for the statistical analysis of programs related to utilization and case management.
  • Participate in NCQA, State, and/or other accreditations of the Plan.
  • Organize and present new concepts, programs and tools to staff and other health plan departments.
  • Serve as a mentor for multiple plans and staff.
  • Develop communication plans with external providers such as hospitals and State agencies as required to facilitate plan goals and objectives.
  • Coordinate with Medical Director to educate and communicate expectations with providers.

    For Michigan Complete Health Only:
  • Support and perform case management, disease management and on site concurrent review functions.
  • Coordinate efforts with the Member Services and Connections Departments to address member and provider issues and concerns in compliance with medical management requirements.
  • 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.
  • Oversee the daily activities of medical management staff. Facilitate on-going communication between care management staff, members, contracted providers, and subsidiaries.
  • Develop staff skills and competencies through training and experience.

  • Qualifications:

    Education/Experience: Bachelor's degree in nursing, related field, or equivalent experience. 7+ years of clinical nursing, quality improvement, and management experience in a managed care setting.

    License/Certification: Current state nursing license.

    For Michigan Complete Health Only: Care management is included in all functions/responsibilities related to this role.
    Education/Experience: 7+ years of clinical nursing, quality improvement, and management experience in a managed care setting, of which 3+ years must be in utilization management.
    License/Certification: RN, licensed nurse practitioner, licensed physician's assistant, licensed Bachelor's prepared social worker, limited license Master's prepared social worker, or licensed Master's prepared social worker. Case Manager Certification 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

    Clinical & Nursing Opportunities at Centene

    Our Clinical team is at the forefront of our purpose-driven work. Learn more about how you can help transform the health of our communities, one person at a time.

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    Care Manager

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    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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