Manager, CM (RN)

Centene
California
Workplace: RemoteFull timeUSD 102,900 - 190,500 annuallyFunction: Healthcare (Clinical, Medical, Wellness)Experience: 5+ yearsEducation: bachelorsSkills: ["Leadership","Collaboration","Communication","Problem-solving"]

Manage the care management team and oversee care management for members to deliver high-quality, cost-effective healthcare outcomes. Lead escalations and complex cases, review care management documentation for federal/state compliance and contractual requirements, and monitor audits against regulatory and NCQA standards. Set team goals, oversee care management metrics and reporting, coach staff on member and provider experience improvements, and support onboarding, hiring, and training.

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Centene
Centene
2 days ago

Manager, CM (RN)

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Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live

Job Summary

Manage the care management team and oversee care management for members to deliver high-quality, cost-effective healthcare outcomes. Lead escalations and complex cases, review care management documentation for federal/state compliance and contractual requirements, and monitor audits against regulatory and NCQA standards. Set team goals, oversee care management metrics and reporting, coach staff on member and provider experience improvements, and support onboarding, hiring, and training.
Location: California
Workplace: Remote
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Manager level

Key Responsibilities

  • •Manage the care management team and oversee care management for members to develop and assess healthcare outcomes.
  • •Manage escalations and complex care management issues related to members or providers.
  • •Oversee review of required care management documentation to maintain compliance with federal/state regulations and contractual agreements.
  • •Direct daily activities, including reviewing and approving caseloads based on state requirements and member needs.
  • •Set goals and objectives for the team and oversee care management data and reporting metrics; monitor audits for compliance with regulatory and NCQA standards.

Pay and Benefits

Salary: USD 102,900 - 190,500 annually
Perks:Health Insurance401kPaid LeaveEquity

Key Requirements

  • •Graduate from an accredited school in nursing or a Bachelor's degree, and 5+ years of related experience.
  • •RN - Registered Nurse state licensure/compact state licensure required.
  • •Must be licensed in California.
  • •Prefer UM and CM experience.
Experience:5+ yearsHealthcare
Education:Bachelor's in Nursing
Skills:LeadershipCollaborationCommunicationProblem-solving
Licenses:RN - Registered Nurse - State LicensureCompact State LicensureCalifornia RN license
Certifications:RN - Registered Nurse

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn