Lead Care Manager

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $87k - $161.3k / year

⏰ Full Time

🟠 Senior

👔 Manager

👻 Ghost score 0%

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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

• Support pediatric and maternity care management populations • Manage complex cases and set up cases • Oversee and review ongoing care plans and service plans, including behavioral health and social determinant needs • Identify providers, specialists, and community resources needed for care • Conduct telephonic, digital, home, and/or other site-visit outreach to assess member needs • Triage complex care-plan issues to appropriate behavioral healthcare providers • Provide guidance and expert knowledge to care management team members • Monitor complex care plans, member status, outcomes, treatment side effects, complications, and clinical symptoms • Review member data to identify health risks and care gaps and recommend interventions in accordance with state and federal regulations • Collaborate with healthcare providers regarding complex cases and revise care plans as needed • Collect, document, and maintain member information and care management activities for regulatory compliance • Train and educate care management teams and providers on treatment options, procedures, referrals, and healthcare benefits • Partner with leadership to improve care and quality delivery cost-effectively • Monitor policies and procedures for compliance with corporate, state, and NCQA standards • Work with senior management on escalated and complex cases and guide junior team members • Review reports to ensure quality and productivity metrics are met • Perform regular staff audits and other assigned duties

🎯 Requirements

• Master's degree in Behavioral Health or Social Work OR a degree from an accredited school of nursing • 5–7 years of related experience • Licensed Master's Behavioral Health Professional (e.g., LCSW, LMSW, LMFT, LMHC, LPC) or RN based on state contract requirements, with behavioral health experience required • Knowledge and experience supporting pediatric and maternity care management populations • Experience managing complex behavioral health and social-needs cases • Ability to support audits, quality control, compliance, and regulatory requirements • Must reside in North Carolina • Availability Monday through Friday, 8:00 AM to 5:00 PM • Approximately 10% travel may be required for occasional meetings or team events in Raleigh or Charlotte

🏖️ Benefits

• Competitive pay • Health insurance • 401K • 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 • Equal opportunity employer committed to diversity