Description
Position Purpose: Directs the long-term care of members to develop and assess high quality, cost-effective healthcare outcomes. Develops strategies and objectives within long-term care management to improve member and/or provider experience.
- Leads long-term care management and care management team on performance, improvement, and career growth path considerations
- Leads long-term care management policies and procedures within the care management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
- Oversees and monitors work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs
- Monitors, reviews, and signs off on contract required reporting as required
- Vendor oversight as required and applicable to the role
- Attends conferences and stays up to date on latest trends and best practices in Payer Care Management and related fields, as applicable
- Leads and presents process improvements for the long-term care management team to achieve cost-effective healthcare results
- Leads and coordinates large or special project work with other departmental functions
- Directs and evaluates departmental operations, including the long-term care management model, staffing, use of information technologies, onboarding, and staff competencies to achieve performance and quality objectives
- Reviews and monitors long-term care member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations, and participates with internal and external audits as required
- Contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care
- Develops long-term care management strategies and influences decisions by providing recommendations that align to organizational objectives
- Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care
- May develop department budget while collaborating inter-departmentally and with senior leadership
- May develop or contribute to developing the overall strategy for onboarding, hiring, and training new long-term care management team members to ensure adequate training and high-quality care to improve member and/or provider experience and ensure compliance
- IL Health Plan Only: Serves as a consumer advocate for MLTSS enrollees, responsible for internal advocacy for these enrollee’s interests, including ensuring input in policy development, planning, decision making and oversight.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience: Requires a Bachelor's degree and 7+ years of related experience, including prior management experience.Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
