Vice President, Medicare Care Management

🕒 August 17

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $188.9k - $359.8k / year

⏰ Full Time

🔴 Lead

👔 Vice President

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Lead the national Medicare Care Management organization, including regional operations, transitions of care, complex care management, duals care management, and specialty programs • Develop and execute the enterprise care management strategy to improve clinical outcomes, member experience, Star Ratings, and medical cost performance • Align care management programs with Medicare Advantage growth, quality, utilization management, LTSS, and value-based care strategies • Partner with executive leadership to establish priorities, performance goals, and multi-year transformation roadmaps • Own Model of Care performance, compliance, audit readiness, and regulatory outcomes • Drive operational excellence through standardized workflows, consistent clinical practices, and performance management across markets • Lead continuous improvement efforts focused on reducing unnecessary variation and improving member outcomes • Ensure care management programs demonstrate measurable impact on quality, utilization, member engagement, and total cost of care • Develop and oversee programs supporting transitions of care, complex care management, chronic condition management, behavioral health integration, and duals populations • Identify and implement opportunities to reduce avoidable admissions, readmissions, emergency department utilization, and post-acute care costs • Partner with Utilization Management, Medical Economics, Network, Pharmacy, and Quality leaders to deliver annual QAI and affordability targets • Translate clinical insights into scalable interventions that improve health outcomes while managing medical expense • Lead modernization of care management capabilities through workflow automation, digital engagement, AI-enabled clinical support, and analytics • Partner with technology teams to improve clinical platforms, reporting, interoperability, and workforce productivity • Drive adoption of data-driven decision making and advanced member targeting strategies • Champion innovation that enhances member outcomes and operational efficiency • Build and develop a high-performing team of regional and functional leaders • Establish a culture of accountability, collaboration, transparency, and continuous improvement • Lead succession planning, workforce strategy, organizational design, and talent development initiatives • Foster strong partnerships across Compliance, Operations, Quality, Medical Affairs, and Health Plan leadership

🎯 Requirements

• Bachelor's Degree with 5+ years of relevant experience required • Significant responsibility for Medicare Advantage Care Management operations • Deep expertise in Model of Care requirements, CMS regulations, NCQA standards, and audit readiness • Demonstrated success improving clinical outcomes, STAR performance, member experience, and medical cost trends • Experience leading large, geographically dispersed teams through transformational change • Proven ability to influence executive stakeholders and drive enterprise-wide initiatives across multiple functions • Current state RN license preferred • Master's Degree preferred

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation