Centene Corporation Senior Director, Medical Management in Troy, Michigan

ProfessionalPosition Purpose: Direct medical management program including utilization management, case management, and quality improvement in accordance with the mission, philosophy, and objectives of the plan and in conjunction with Corporate goals and objectives.

  • Develop department objectives and organize activities to achieve objectives.

  • Evaluate and implement changes to medical service functions and performance in relation to company mission, philosophy objectives and policies for multiple health plans.

  • Participate as a subject matter expert in implementation of new health plans.

  • Manage budget and forecast for strategic planning and key initiatives.

  • Coordinate with operating departments on research and implementation of best practices.

  • Responsible for the statistical analysis of programs related to utilization and case management.

  • Participate in NCQA, State, and/or other accreditations of the Plan.

  • Organize and present new concepts, programs and tools to staff and other health plan departments.

  • Serve as a mentor for multiple plans and staff.

  • Develop communication plans with external providers such as hospitals and State agencies as required to facilitate plan goals and objectives.

  • Coordinate with Medical Director to educate and communicate expectations with providers.For Michigan Complete Health Only:

  • Support and perform case management, disease management and on site concurrent review functions.

  • Coordinate efforts with the Member Services and Connections Departments to address member and provider issues and concerns in compliance with medical management requirements.

  • Develop, implement, and maintain care management programs to facilitate the use of appropriate services and resources in order to maintain the member in the least restrictive environment.

  • Oversee the daily activities of medical management staff. Facilitate on-going communication between care management staff, members, contracted providers, and subsidiaries.

  • Develop staff skills and competencies through training and experience.

For Michigan Complete Health Only: Care management is included in all functions/responsibilities related to this role.

Education/Experience: 7+ years of clinical nursing, quality improvement, and management experience in a managed care setting, of which 3+ years must be in utilization management.

License/Certification: RN, licensed nurse practitioner, licensed physician's assistant, licensed Bachelor's prepared social worker, limited license Master's prepared social worker, or licensed Master's prepared social worker. Case Manager Certification preferred.

MI licensed RN highly preferred.

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.

TITLE: Senior Director, Medical Management

LOCATION: Troy, Michigan

REQNUMBER: 1118135

COMPANY: Clinical & Nursing, Leadership

POSITION TYPE: Professional