Director, Care Management - LTSS

Centene Management Company LLC; Illinois; Hybrid; USD 127,000 - 236,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene Management Company LLC seeks an experienced leader to direct long-term care management in Illinois, developing strategies to improve member and provider experiences and driving high-quality, cost-effective healthcare outcomes.

Applicants must reside in Illinois or be willing to relocate and have deep LTSS expertise with strong data analysis, leadership, and presentation skills. Managed care experience is highly preferred.

Qualifications

• Bachelor's degree required; 7+ years of related experience including management.

Responsibilities

• Directs long-term care management and care management team on performance and career growth.
• Leads policies and procedures to ensure compliance with state and NCQA standards.
• Oversees caseloads and staffing based on state requirements and member needs.
• Monitors and signs off on required reporting; vendor oversight as applicable.
• Keeps up-to-date on trends in Payer Care Management and best practices.
• Leads process improvements for cost-effective healthcare results.
• Coordinates large or special projects with other departments.
• Directs department operations including model, staffing, IT usage, onboarding and training.
• Reviews long-term care member data to identify trends and improve performance and quality.

Education

Bachelor's degree

Job 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. Applicants must reside in the state of Illinois or be open to relocating. Seeking an experienced leader with deep expertise in LTSS and Waiver programs to lead care management operations in Illinois. Candidates must reside in Illinois and be comfortable presenting to leadership, analyzing data, and driving performance outcomes. Managed care experience is strongly preferred.

Responsibilities

• 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.

Pay Range

Pay Range: $127,300.00 - $236,100.00 per year

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.

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

About Centene

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.

Company Culture

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.

EEO Statement

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.