Centene Corporation is seeking a Vice President, Medical Management for their health plan in Nebraska. Nebraska Total Care is one of three managed care entities that will serve a significant percentage of Nebraska’s estimated 230,000 Medicaid beneficiaries as of January 2017. Centene serves more than 11 million members through programs and services to government-sponsored health care programs, focusing on under-insured and uninsured individuals. Fortune Magazine has ranked Centene Corporation No. 124 in its annual FORTUNE 500® list of largest corporations in the United States, ranked by revenue.
Reporting to the Chief Executive Officer and Plan President, and the Corporate Vice President, Medical Management Operations, this role will lead the development and implementation of short term, long term, and cost saving initiatives for Nebraska Total Care plans and products. The Vice President, Medical Management will oversee all aspects of disease and care management processes, and play a key role in the strategic development of the health plan, interacting with key stakeholders and regulatory authorities.
- RN degree, prior experience leading the care management process in a health plan or health system with a risk-based arrangement (ACO or value-based reimbursement).
- Thorough understanding of medical information systems, medical claims payment process, coding, and case management practices, preferably in the governmental setting.
- Proven background leading case managers, including responsibilities for hiring, training, assessment, and managing the performance of staff.
- Familiarity of National Committee on Quality Assurance (NCQA) accreditation process and standards.