Manager, Pediatric Care Management

Sunshine Health; Orlando (FL); Remote; USD 100,000 - 187,000; Full time

Job summary

A leading company in healthcare is seeking a Manager for Pediatric Care Management. The role involves overseeing the care management team to deliver high-quality, cost-effective healthcare outcomes. Candidates must have a Master's degree and significant experience in pediatrics along with relevant licensure. This remote position offers a comprehensive benefits package and requires a commitment to improving member experiences in mental and behavioral health.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Qualifications

• Requires a Master's degree or equivalent nursing qualification.
• 5+ years of related experience including pediatrics.
• Licensed Clinical Behavioral Health Professional or RN required.

Responsibilities

• Manages care management team and escalated care cases.
• Oversees compliance with regulations and documentation.
• Develops and implements care management policies.

Skills

Management

Care Coordination

Behavioral Health Knowledge

Education

Master's degree

Degree from an Accredited School of Nursing

Job description

Join to apply for the Manager, Pediatric Care Management role at Sunshine Health.

This position is remote. Candidates should reside and hold licensure in the State of Florida to be considered.

Candidates must be willing to work one of the following schedules:

• Tuesday - Saturday, 8 hours per day
• Wednesday - Saturday, 10 hours per day

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.
• 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 promotions, and transfers within the department.
• Performs other duties as assigned and complies with all policies and standards.

Education/Experience: Requires a Master's degree or a degree from an Accredited School of Nursing and 5+ years of related experience including pediatrics.

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: $100,900.00 - $186,800.00 per year.

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 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 without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by law. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.