Manager, CM – RN

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $102.9k - $190.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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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

• Manage the care management team and care management of members • Develop and assess high-quality, cost-effective healthcare outcomes • Manage escalations and care management issues related to members or providers • Oversee and review required care management documentation for regulatory and contractual compliance • Develop and implement care management team policies and procedures • Direct daily activities of care management staff, including reviewing and approving caseloads • Manage escalations and complex cases and guide team members • Coordinate resolutions of member escalations and complaints • Assist with audits and evaluations related to care programs and member concerns • Develop, implement, and oversee care management programs • Perform telephonic, digital, home, and/or other site outreach to assess member needs • Set team goals and oversee care management data and reporting metrics • Monitor care management audits for compliance with federal, state, and NCQA standards • Provide feedback to improve member and provider experience and quality of care • Educate and provide resources to the care management team on key initiatives and member outreach • Assist senior leadership with onboarding, hiring, and training team members • Lead and champion change within the scope of responsibility • Perform other duties as assigned

🎯 Requirements

• RN license for the state of California required • Graduate from an accredited school of nursing or a bachelor's degree • 5+ years of related experience • Prefer UM and CM experience • RN state licensure and/or compact state licensure required • Must be licensed in California • Ability to work PST hours • Compliance with all policies and standards

🏖️ 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 • Accommodation support available