Position Purpose: Perform duties to conduct and manage the day
to day operations of the case management functions communicating
with departmental and plan administrative staff to facilitate daily
Review analyzes of activities, costs, operations and forecast
data to determine progress toward stated goals and
Promote compliance with federal and state regulations and
Develop, implement and maintain compliance with policies and
procedures regarding medical case management.
Develop, implement, and maintain case management programs to
facilitate the use of appropriate medical resources and decrease
health plan financial exposure.
Facilitate on-going communication between case management staff,
members, contracted providers, and subsidiaries.
Develop staff skills and competencies through training and
Education/Experience: Bachelor's degree in Nursing or equivalent
experience. 3 years case management experience and recent nursing
experience in an acute care setting particularly in
medical/surgical, pediatrics, or obstetrics and management
experience. Thorough knowledge of case and/or utilization
management and clinical nursing. Familiarity with Medicaid managed
care practices and policies, CHIP, and SCHIP. Previous experience
as a lead in a functional area, managing cross functional teams on
large scale projects or supervisory experience including hiring,
training, assigning work and managing the performance of staff.
License/Certification: Unrestricted RN license in applicable
state(s) and valid driver's license and automobile insurance. Case
Management Certification (CCM) preferred.
For Oklahoma Complete Health: RN, LCSW, LPC, or LMFT is
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.