Manager, Care Management

Centene Management Company LLC; Kentucky; Hybrid; 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 work arrangements

Job summary

Centene Management Company LLC is seeking a remote Manager of Care Management to lead a team of clinicians supporting the Buckeye Medicaid plan. The candidate must reside in Ohio with an active clinical license and strong leadership in behavioral health and managed care.

The role emphasizes case management, utilization review, and compliance with federal/state regulations. Experience in community mental health and audits is valued, with opportunities to guide policy and program development.

Qualifications

• Master's degree or graduate from an Accredited School of Nursing.
• 5+ years of related experience in behavioral health or managed care.

Responsibilities

• Oversees and reviews care management documentation to ensure compliance with regulations and contracts.
• Develops, implements, and oversees care management policies and procedures.
• Directs daily activities of care management staff and reviews caseloads to meet state requirements and member needs.
• Manages escalated and complex care cases and provides guidance to address member concerns.
• Develops programs to facilitate appropriate services and resources and supports audits and evaluations.

Skills

Leadership experience

Behavioral health

Managed care

Case management

Utilization review

Education

Master's degree in Nursing

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.

Responsibilities

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 ongoing 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

Company Culture

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 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.

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

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.