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.

This is a remote position with regional travel required. Candidates must be able to travel up to 25% of the time in this role.

Position Purpose: Supervise the day to day operations of the case management function. Communicate with departmental and plan administrative staff to facilitate daily department functions.

• Assure compliance with established referral, pre-certification and authorization policies, procedures and processes by related Medical Services staff.
• Assure compliance with established onsite and concurrent review, case management, referral, pre-certification and authorization policies, procedures and processes.
• Assure compliance with emergency management policies, procedures and processes.
• Facilitate on-going communication between case management staff, utilization management staff and contracted providers.
• Assist with the implementation of policies and procedures regarding medical case management.
• Maintain compliance with federal and state regulations and contractual agreements.
• Coordinate and communicate medical service functions with other departmental functions.
• Act as medical resource for appeals function.
• Assist Medical Services staff with computer systems issues related to case management.
• Conduct telephonic review of cases with doctors, hospitals, and other providers.
• Compile and review multiple reports for statistical and financial tracking purposes to identify case management trends and assist in financial forecasting.
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: 3 years of nursing experience in an acute care setting particularly in a medical/surgical, pediatrics, or obstetrics environment. 1 year of case and/or utilization management experience. Working knowledge of a specialized or technical field such as clinical nursing, case and/or utilization management. Previous experience as a lead in a functional area or managing cross functional teams on large scale projects. Data management experience preferred.
License/Certification: Valid driver's license. Current state's RN license. License must be current, valid and active.
For Florida plan only: RN, LCSW, LCMHC or other Clinical Mental Health Professional license required.
Employees supporting Florida's Children’s Medical Services (CMS) must have a minimum of 3 years of management/supervisory experience in the health care field and at least 2 years of pediatric experience.

Additional Information:

• Location: This is a remote position with up to 25% travel required. Candidates must reside in the state of Florida to be considered for this position. Regional travel is required.

• License: RN, LCSW, LCMHC or other Clinical Mental Health Professional license required.

• Experience: Requirement of 3 years of management/supervisory experience in the health care field and at least 2 years of pediatric experience to be considered.

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 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. Total compensation may also include additional forms of incentives.

About the Company:
Sunshine State Health Plan