Supervisor, Care Management
Company: Oklahoma Complete Health
Posted on: November 20, 2023
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
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's 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' situations and functioning,
assuring identification of individual needs.
Assures assessment information is used to develop a comprehensive
care management plan to address the members' needs.
Manages the planning process to assure the specific objectives,
goals and actions are designed to meet the members' 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
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
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's
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
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
Communicates with providers, members and community resources as
necessary to support the planning, implementation and evaluation of
the patient's 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
License/Certification: Current, valid and unrestricted professional
licensure is required; Current, valid and unrestricted RN
For Shared Services: Clinical licensure for multiple states is
For Illinois plan only: Five years of clinical experience required
and two years of supervisory experience preferred, preferably with
HMO experience in a medical management capacity.
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.
Keywords: Oklahoma Complete Health, Stillwater , Supervisor, Care Management, Executive , Stillwater, Oklahoma
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