Job Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Must live in Oklahoma

Oklahoma Complete Health, a Centene company, is committed to providing quality healthcare solutions to transform the health of Oklahomans.

At Oklahoma Complete Health, we are community advocates and change-makers in search of an inclusive culture grounded by our commitment to work-life balance, competitive compensation, and continuous career development. Join us and be a part of a collaborative, growing network of innovative thinkers delivering solutions at the local level.

Position Purpose: Under the direction of the Director of Care Management, the Supervisor of Care Management is responsible for implementing the Care Management programs in multiple environments including Prior Authorization, Concurrent Review and Care Management. Manages the daily operational processes to assure the continuum of care that addresses the ongoing needs of the members served by the care management process. A patient advocacy approach with a seamless integration of services is required and must be balanced within the member\xe2\x80\x99s benefit structure. Emphasis will be placed on continuity of care, assisting members in obtaining access to care, and member education.

• Directs personnel supervision of associates to include hiring, training and performance evaluations.
• Assures appropriate triage of members at risk.
• Supervises the assessment of members\xe2\x80\x99 situations and functioning, assuring identification of individual needs.
• Assures assessment information is used to develop a comprehensive care management plan to address the members\xe2\x80\x99 needs.
• Manages the planning process to assure the specific objectives, goals and actions are designed to meet the members\xe2\x80\x99 needs as identified throughout the planning process.
• Responsible for implementing and coordinating activities that will lead to the accomplishment of goals set forth in the care management plan.
• Performs resource management, and organizes, secures, integrates and modifies resources to meet the goals.
• Assures processes are in place to identify deficits between benefits and member requirements, and utilizes community and ancillary services to assure continuity of care for the member.
• Performs the direct supervision of care managers, assures the proactive identification of members at risk and in need of care management services, and identifies educational opportunities.
• Assesses caseloads and realigns assignments to meet organizational needs.
• Works in collaboration with Medical Informatics and the Quality Improvement departments and monitors programs to meet the needs of our membership and those in the Care Management process.
• Monitors information from all relevant sources about the care management plan and activities to determine the plan\xe2\x80\x99s effectiveness.
• Performs the daily activities necessary to evaluate the effectiveness of the care management plan at appropriate intervals, and determines if outcomes were successful and goals were met.
• Works in collaboration with the Care Management Directors in each state to identify areas of opportunity and/or provider education.
• Maintains Care Management vendor relationships on a daily and aggregate basis to assure the care given to our members is appropriate and compliant with PHS policies and governmental regulatory requirements.
• Communicates with providers, members and community resources as necessary to support the planning, implementation and evaluation of the patient\xe2\x80\x99s plan of care.
• Performs audit activities as required, and participates in establishment of corrective action as necessary.
• Assures the use of appropriate criteria when making decisions.
• Performs Care Management activities as required.

Education/Experience: CCM, Baccalaureate degree preferred; MSW with appropriate care management experience may be considered. Five years of clinical experience and at least two years of supervisory experience, preferably with HMO experience in a medical management capacity.

License/Certification: Current, valid and unrestricted professional licensure is required; Current, valid and unrestricted RN preferred

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.

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