Position Purpose: Leads and directs the long-term care management of members with physical/medical health and/or behavioral/mental health care needs to develop and assess high quality, cost- effective healthcare outcomes. Leads and develops strategies and objectives within care management to improve member and/or provider experience.

Key Details: Must reside in Indiana or be willing to relocate to Indiana. A minimum of 5 years of LTSS experience is required. This role serves as the LTSS subject matter expert, leading RFP development and submissions while supporting the design, implementation, and growth of LTSS programs.

• Provides oversight and leadership to the development, implementation, monitoring, and ongoing improvement of the long-term care management process
• Develops and provides senior leadership team a vision and direction for the department to achieve functional goals, and effectively communicates these goals to the long-term care management team
• Oversees and monitors work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs
• Monitors, reviews, and signs off on contract required reporting, as required
• Vendor oversight, as required and applicable to the role
• Leads and enforces long-term care management policies and procedures within the care management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
• Attends conferences and stays up to date on latest trends and best practices in Payer Care Management and related fields, as applicable
• Leads and coordinates large or special project work with other departmental functions
• Provides subject matter expert guidance to senior leadership and long-term care management team, which may include the latest long-term care management policies, procedures, and standards
• Reviews and monitors long-term care member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations, and participates with internal and external audits as required
• Reviews internal reports to ensure adherence to department budget and identify trends to effectively forecast
• Implements long-term care management strategies that align to organizational objectives
• Engages with onboarding, hiring, and training new long-term care management team members to support future growth and strategy
• Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care
• Leads and manages process improvements for the long-term care management team to achieve cost-effective healthcare results and presents to senior leadership team as applicable
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Positions Primarily overseeing RN team members: Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 10+ years of related experience, including prior management experience. Or,
Positions Primarily overseeing BH team members: Requires a Master's degree or Graduate from an Accredited School of Nursing and 10+ years of related experience, including prior management experience.

Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

5+ years management 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.

License/Certification:

• Positions overseeing RN team members: Current state's Registered Nurse (RN) license preferred or
• Positions overseeing BH team members: Licensed Clinical Behavioral Health Professional or RN based on state contract requirements e.g., LCSW, LMSW, LMFT, LMHC, and RN with BH experience required preferred

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act