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Manager, Care Management

2 months ago

Newark, United States Centene Corporation Full time

Position Purpose: Manages the care management team and the care coordination of behavioral health members to develop and assess high quality, cost-effective healthcare outcomes related to mental and behavioral health needs. Manages escalations and care management issues related to members or providers. Oversees and reviews care management required documentation to maintain compliance with federal and state regulations and contractual agreements Develops, implements, and oversees care management policies and procedures within the care management team based on regulatory requirements and industry standards Directs the daily activities of care management staff including reviewing and approving the caseloads of care management staff based on state requirements, care management staff experience, and member needs Manages escalated and complex care cases, and provides guidance to team members to address member concerns related to mental and behavioral health members Manages resolutions of complaints and assists in audits and evaluations related to care programs Develops, implements, and oversees care management programs to facilitate the use of appropriate services and resources Sets goals and objectives for care management team to achieve cost-effective healthcare results Works with care management senior management to provide updates and insights on care management team goals Provides feedback to care management team to improve member and provider experience and high-quality care Educates and provides resources for care management team on key initiatives and member outreach to facilitate on-going communication between care management team, members, and providers Assists care management senior leadership with onboarding, hiring, and training new care management employees, recent promotes, and transfers within the department Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires a Master's degree or Graduate from an Accredited School of Nursing and 5+ years of related experience. License/Certification: Licensed Clinical Behavioral Health Professional or RN based on state contract requirements e.g., LCSW, LMSW, LMFT, LMHC, and RN with BH experience required

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