Centene Corporation is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government-sponsored healthcare programs, focusing on under-insured and uninsured individuals. Founded as a single health plan in 1984, Centene Corporation has established itself as a national leader in the healthcare services field. Today, Centene works with more than 11 million members in 29 states with government-sponsored healthcare programs and initiatives. Fortune Magazine has ranked Centene Corporation No. 124 in its annual FORTUNE 500 list of largest corporations in the United States, ranked by revenue, up from 186 last year.
Centene seeks a Regional Vice President, Medical Management for the northeast region. Centene’s northeast region includes Massachusetts, Michigan, New Hampshire, Ohio, Pennsylvania, and South Carolina. The Regional Vice President will be domiciled within Centene’s northeast region. Reporting to the Corporate Vice President, Medical Management Operations, the Regional Vice President, Medical Management will plan, develop, and drive execution of Medical Management and Quality Improvement programs, processes, and initiatives to ensure improved quality outcomes, achievement of health benefit ratio targets, and reduction in administrative costs. This role will drive adoption of best practices and standardization, while developing customized approaches for unique markets and product lines.
- Prior experience leading the care management process, managing staff and workload performance.
- Ten or more years of clinical nursing, quality improvement, and management experience in a managed care setting.
- Solid understanding of appropriate metrics, measures, and outcomes, displaying a keen ability to work in a data driven environment.
- Thorough understanding of medical information systems, medical claims payment processes, coding, provider contracting approaches, and case management practices, preferably in the governmental setting.
- Ability to implement change in a consultative approach and maneuver in a matrix reporting environment. Six Sigma experience preferred.
- RN; Bachelor’s degree in Nursing, related field, or equivalent experience; masters preferred.