Manager, Case Management

3 weeks ago

Tucson, Arizona, United States Centene Corporation Full time

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Candidate must reside in state of Arizona

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

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 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.

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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