Manager, Care Management

Centene Corporation; Columbus (OH); Remote; USD 103,000 - 191,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible remote/hybrid/onsite work SHe

Job summary

Centene Corporation is seeking a remote Manager, Care Management to lead the care management team focused on behavioral health within the Buckeye Medicaid plan. You will oversee clinician performance, escalation handling, and ensure regulatory compliance across federal and state requirements.

The role requires Ohio residency and an active clinical license, with leadership background in behavioral health, managed care, case management or community mental health.

Qualifications

• Requires a Master's degree in Nursing or related field and 5+ years of related experience.
• Must reside in Ohio and hold an active clinical license in the state.
• Leadership experience with a strong background in behavioral health, managed care, case management or community mental health centers.

Responsibilities

• Oversees and reviews care management documentation to ensure compliance with federal and state regulations and contracts.
• Develops and oversees care management policies and procedures.
• Directs daily activities of care management staff and approves caseloads according to state requirements and member needs.
• Manages escalated and complex care cases and provides guidance to staff.
• Manages resolutions of complaints and assists in audits and evaluations related to care programs.
• Develops, implements, and oversees care management programs to facilitate appropriate services and resources.
• Sets goals for the team to achieve cost-effective healthcare results.
• Coordinates with senior management to provide updates on team goals and performance.
• Provides feedback to improve member and provider experience and high-quality care.
• Educates and supports care management staff on initiatives and member outreach.

Skills

Leadership

Behavioral health

Managed care

Case management

Utilization review

Communication

Education

Master's degree in Nursing or related field

Job description

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.

Key details

Centene is hiring a remote Manager, Care Management, to support our Buckeye Medicaid plan and oversee a team of clinicians. The selected candidate must reside in Ohio and hold an active clinical license in the state. The ideal candidate will bring leadership experience along with a strong background in behavioral health, managed care, case management or community mental health centers, and utilization review, as well as excellent communication and presentation skills.

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

Pay Range

$102,900.00 - $190,500.00 per year

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 us

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.

Equal Opportunity

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