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Vice President, Medical Management

Company: Centene Corporation
Location: Baton Rouge
Posted on: September 13, 2020

Job Description:

LA Healthcare Connections Baton Rouge, Louisiana

As a member of the Centene Medical Management/Health Services team, you’ll help innovate and execute strategies that redefine the industry standard for improving the lives and health of people. We’re a team of skilled physicians, nurses, pharmacists, social workers and health service experts who use our advanced clinical analytics to implement award winning programs, develop care, deliver partnerships, and work directly with our members to achieve outcomes that set us apart as industry leaders. Together, we’re transforming the health of communities, one person at a time.

What does it take? What are the qualities that will help you achieve success in this role at Centene?

Success Profile Our Medical Roles Medical Director To help support the individual needs of members and develop programs that address issues, you’ll review population health data, help design clinical programs, and develop care delivery partnerships.

Clinical & Nursing Opportunities at Centene Our Clinical team is at the forefront of our purpose-driven work. Learn more about how you can help transform the health of our communities, one person at a time.

Overall Medical Management A member of the Centene Medical Management team, we innovate and execute strategies that redefine the industry standard for improving the lives and health of people.

Concurrent Review Nurse To ensure our members get the best quality of care, you’ll assess acute member health conditions, treatment and intervention options, and match them with providers, community and health plan resources.

Prior Authorization Nurse You’ll ensure our members get the best quality services, assistive devices, and equipment to promote optimal health and independence in the community and help promote health and independence.

Care Manager Working directly with members, interdisciplinary care team, providers and data analytics, you’ll identify member health risks and conditions and intervention and service options.

LTSS Program Specialist/Program Specialist Field Based Working directly with our most vulnerable members, you’ll identify individual member health risks and opportunities to enhance independence, quality of life and community engagement.

Referral Specialist You’ll use our data systems to directly assist providers, requesting services and treatments for our members.

Medical Director To help support the individual needs of members and develop programs that address issues, you’ll review population health data, help design clinical programs, and develop care delivery partnerships.

Clinical & Nursing Opportunities at Centene Our Clinical team is at the forefront of our purpose-driven work. Learn more about how you can help transform the health of our communities, one person at a time.

Overall Medical Management A member of the Centene Medical Management team, we innovate and execute strategies that redefine the industry standard for improving the lives and health of people.

Concurrent Review Nurse To ensure our members get the best quality of care, you’ll assess acute member health conditions, treatment and intervention options, and match them with providers, community and health plan resources.

Prior Authorization Nurse You’ll ensure our members get the best quality services, assistive devices, and equipment to promote optimal health and independence in the community and help promote health and independence.

Care Manager Working directly with members, interdisciplinary care team, providers and data analytics, you’ll identify member health risks and conditions and intervention and service options.

LTSS Program Specialist/Program Specialist Field Based Working directly with our most vulnerable members, you’ll identify individual member health risks and opportunities to enhance independence, quality of life and community engagement.

Referral Specialist You’ll use our data systems to directly assist providers, requesting services and treatments for our members.

Medical Director To help support the individual needs of members and develop programs that address issues, you’ll review population health data, help design clinical programs, and develop care delivery partnerships.

Responsibilities Job ID 1184857

Category Clinical & Nursing

Schedule Full-time

Description:

Position Purpose: Perform duties to direct and coordinate the medical management, quality improvement and credentialing functions for the assigned health plan based on, and in support of the company’s strategic plan; establishing the strategic vision and attendant policies and procedures.

Direct and coordinate activities of department and aid the chief officer of the health plan and appropriate corporate staff in formulating and administering organizational and departmental policies.

Review analyses of activities, costs, operations and forecast data to determine department progress toward stated goals and objectives.

Serve as a member of management committees on special studies.

Administer and ensure compliance with National Committee on Quality Assurance (NCQA) and/or Joint Commission on Accreditation of Healthcare Organization (JACHO) standards as determined for accreditation of the health plan.

Participate in, attend and plan/coordinate staff, departmental, committee, sub-committee, community, State and other activities, meetings and seminars.

Participate in provider education and contracting, as necessary.

Qualifications:

Education/Experience: Bachelor's degree in Nursing, related field or equivalent experience. 10+ years of clinical nursing, quality improvement, and management experience in a managed care setting. Thorough knowledge of a specialized or technical field such as clinical nursing, managed care, and healthcare administration.

Thorough skills knowledge of quality improvement practices. Working knowledge of medical information systems, medical claims payment process, medical terminology and coding, case management practices, managed care, and Medicaid programs.

Familiarity of National Committee on Quality Assurance (NCQA) accreditation process and standards. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

License/Certification: Current state nursing license.

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.

See what's near our Baton Rouge location.

“I assisted with one of the Provider fairs in the community. Seeing how much we care for our community and our patients was very eye opening.”

- Julie Boulch, Director, Business Implementation Health Plan Initiatives

“Centene is an exciting company to work for, the pace at which we’re growing allows numerous advancement opportunities. Also, we foster an environment that supports and offers numerous leadership growth opportunities.”

- Esmeralda Baig, SVP Operations, Complex Care Products

“I assisted with one of the Provider fairs in the community. Seeing how much we care for our community and our patients was very eye opening.”

- Julie Boulch, Director, Business Implementation Health Plan Initiatives

“Centene is an exciting company to work for, the pace at which we’re growing allows numerous advancement opportunities. Also, we foster an environment that supports and offers numerous leadership growth opportunities.”

- Esmeralda Baig, SVP Operations, Complex Care Products

“I assisted with one of the Provider fairs in the community. Seeing how much we care for our community and our patients was very eye opening.”

- Julie Boulch, Director, Business Implementation Health Plan Initiatives

Our Awards Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.

Learn more about our hiring process and discover other helpful information for applicants.

“Flexibility is key. Centene is a company of change.” Ashley Collier Started as a Referral Specialist, now a Project Manager IV

See Ashley's career path

Join our Talent Network and get Centene news and job alerts delivered to your inbox.

Let us search jobs for you based on the skills and experience listed in your LinkedIn Profile.

Transforming the health of the community, one person at a time. Our local approach allows us to help members access high-quality, culturally sensitive healthcare services.

We invest in local communities and the lives of our members in as many ways as we can.

Stay safe from recruitment fraud! The only way to apply for a position at Centene is via our Careers website. Learn how to protect yourself from recruitment fraud.

Keywords: Centene Corporation, Baton Rouge , Vice President, Medical Management, Other , Baton Rouge, Louisiana

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