RN Director, LTSS Clinical Care Management

Job not on LinkedIn

🔥 17 hours ago

⚜️ Louisiana, New Mexico, +2 more states – Remote

⚜️ Louisiana – Remote 🌶️ New Mexico – Remote 🌪️ Oklahoma – Remote 🤠 Texas – Remote

💵 $133.7k - $247.4k / year

⏰ Full Time

🔴 Lead

👔 Director

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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

• Direct the long-term care of members with physical/medical and/or behavioral/mental health needs • Develop and assess high-quality, cost-effective healthcare outcomes • Develop strategies and objectives within long-term care management to improve member and provider experience • Lead a team of RN managers • Lead development, implementation, monitoring, and ongoing improvement of the long-term care management process • Set team goals and objectives and oversee care management data and reporting metrics • Lead long-term care management policies and procedures to ensure compliance with corporate, state, and NCQA standards • Oversee work assignments and caseloads based on state requirements, staff experience, and member needs • Monitor and sign off on contract-required reporting • Provide vendor oversight • Attend conferences and stay current on trends and best practices in Payer Care Management • Lead and present process improvements • Coordinate large or special projects with other departments • Direct and evaluate departmental operations, staffing, information technologies, onboarding, and staff competencies • Review member data to identify trends and improve performance and quality care • Participate in internal and external audits • Contribute to clinical care pathways • Develop strategies and recommendations aligned with organizational objectives • Coach and guide the care management team • Develop the department budget with senior leadership and other departments • Develop onboarding, hiring, and training strategy • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Graduate from an Accredited School of Nursing • 7+ years of related clinical nursing experience, including current or prior management experience, or equivalent experience acquired through applicable knowledge, duties, scope and skill • Current state’s Registered Nurse (RN) license required or Compact Nursing License • RUG certification must be obtained within 90 days of hire for Superior Health Plan; must be RUG certified if overseeing RN team members • At least 4+ years of leadership experience managing RNs in a managed care organization or a state government agency • Experience in Value-Based Care Management, especially in Child Welfare, Medicaid/Managed Care, CHIP/CHIPS, STAR Kids, or STAR Health programs • Texas DFPS background check required • BSN is preferred • 4+ years of direct RN managerial experience preferred • Expert knowledge of industry regulations, policies, and standards preferred • Highly advanced clinical knowledge and ability to assess member needs in context of relevant diagnoses, treatment plans and goals, and identify potential gaps in care or risks for readmission or complications preferred • Strong knowledge of healthcare managed care principles preferred • Experience working with providers and healthcare teams to develop appropriate long-term service plans/care plans preferred • Strong knowledge of medication indications and side effects preferred • Experience with data analysis, health informatics, clinical reporting, and change management is a plus

🏖️ Benefits

• 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 • Mileage reimbursement for travel • Additional forms of incentives may be included in total compensation