Description: Position Purpose\\: Oversee case management operations for the health plan. Define and direct the case management program for the plan in conjunction with corporate goals and objectives. Lead and direct the overall operation of the case management function to ensure consistency of policies, procedures and work flows Ensure member and provider satisfaction with case management program Evaluate case management program effectiveness and recommend improvements Ensure case management targets for all products are met for the annual operating plan, state requirements and financial management Ensure that utilization management process is integrated with case management program Maintain compliance with National Committee for Quality Assurance (NCQA) standards for case management function. Identify quality and risk management issues and facilitate the collection of information for quality improvement and reporting Review various reports and identify trends to assist in financial forecasting
Qualification: Education/Experience\\: Bachelor's degree in Nursing, related field, or equivalent experience. 7+ years of nursing experience in an acute care setting or complex case management experience. Experience in managed care environment. License/Certification\\: RN license.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Associated topics: chief marketing officer, donor, endowment, media, medical center, public, public relations, regulatory, relation, social media