Director, Care Management - LTSS

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Pennsylvania Resident Highly Preferred. Up to 25% travel across PA and occasional reporting to a PA office.

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.

• 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
• Performs other duties as assigned

Requirements

• 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

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

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules

Benefits may be subject to program eligibility.