护理管理主管 - 长期护理服务
Director, Care Management - LTSS
职位职责：负责长期护理成员的长期管理，以制定和评估高质量、成本效益的医疗结果。在长期护理管理中制定策略和目标，以提升成员和/或供应商的体验。
寻找一位在LTSS（长期护理服务）和豁免计划方面有深厚专业知识的经验丰富的领导者，负责伊利诺伊州的护理管理运营。候选人必须居住在伊利诺伊州，并能够向领导层进行汇报、分析数据并推动绩效成果。具有管理护理经验者优先。
- 领导长期护理管理和护理管理团队在绩效、改进和职业发展路径方面的考虑
- 在护理管理团队内领导长期护理管理政策和流程，确保符合公司、州和国家质量保证委员会（NCQA）的标准
- 根据州要求、护理管理人员经验和成员需求，监督和监控长期护理管理人员的工作任务和案件量
- 监督、审查并签署合同要求的报告
- 按需进行供应商监督
- 参加会议并了解支付方护理管理及相关领域的最新趋势和最佳实践
- 领导并为长期护理管理团队提出流程改进方案，以实现成本效益的医疗结果
- 与其他部门职能协作，领导和协调大型或特殊项目工作
- 指导和评估部门运营，包括长期护理管理模型、人员配置、信息技术使用、入职培训和员工能力，以实现绩效和质量目标
- 审查和监控长期护理成员数据，识别趋势并根据州和联邦法规改善运营绩效和优质护理，按需参与内部和外部审计
- 为临床护理路径的发展和改进做出贡献，以提高成本效益同时提供高质量护理
- 制定长期护理管理策略，并通过提供与组织目标一致的建议来影响决策
- 为长期护理管理团队提供指导和辅导，以提升成员和供应商的体验并促进高质量护理的交付
- 可能需要在跨部门协作中制定部门预算
查看英文原文
Position Purpose: Directs the long-term care of members to develop and assess high quality, cost-effective healthcare outcomes. Develops strategies and objectives within long-term care management to improve member and/or provider experience.
Seeking an experienced leader with deep expertise in LTSS and Waiver programs to lead care management operations in Illinois. Candidates must reside in Illinois and be comfortable presenting to leadership, analyzing data, and driving performance outcomes. Managed care experience is strongly preferred.
- Leads long-term care management and care management team on performance, improvement, and career growth path considerations
- Leads long-term care management policies and procedures within the care management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
- Oversees and monitors work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs
- Monitors, reviews, and signs off on contract required reporting as required
- Vendor oversight as required and applicable to the role
- Attends conferences and stays up to date on latest trends and best practices in Payer Care Management and related fields, as applicable
- Leads and presents process improvements for the long-term care management team to achieve cost-effective healthcare results
- Leads and coordinates large or special project work with other departmental functions
- Directs and evaluates departmental operations, including the long-term care management model, staffing, use of information technologies, onboarding, and staff competencies to achieve performance and quality objectives
- Reviews and monitors long-term care member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations, and participates with internal and external audits as required
- Contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care
- Develops long-term care management strategies and influences decisions by providing recommendations that align to organizational objectives
- Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care
- May develop department budget while collaborating inter-departmentally and with senior leadership
- May develop or contribute to developing the overall strategy for onboarding, hiring, and training new long-term care management team members to ensure adequate training and high-quality care to improve member and/or provider experience and ensure compliance
- IL Health Plan Only: Serves as a consumer advocate for MLTSS enrollees, responsible for internal advocacy for these enrollee’s interests, including ensuring input in policy development, planning, decision making and oversight.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience: Requires a Bachelor's degree and 7+ years of related experience, including prior management experience.Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
Pay Range: $127,300.00 - $236,100.00 per year
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Originally posted on Himalayas