Carolina Complete Health

Conduct quality reviews and audits of delegated healthcare entities, manage clinical initiatives, investigate complaints, and coordinate quality improvement activities. | Bachelor’s degree in Nursing preferred, 3+ years clinical or quality improvement healthcare experience, 2+ years quality function experience, and relevant clinical licenses or certifications preferred. | You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Must reside in the state of North Carolina. Position Purpose Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communicate with agencies and providers. • Perform quality on site reviews of delegated entities, physician office/clinics, resolve quality issues, generate written summary of findings and follow up as directed by the Medical Director and/or Credentialing and Quality Improvement Committee (QIC). • Document, investigate and resolve formal and informal complaints, risk management and sentinel events related to quality of care issues. • Audit medical records, review administrative claims and analyze data and interventions for quality improvement studies and activities • Function as the primary liaison between community resources/agencies and the company related to clinical initiatives and technical guidance. • Schedule and chair meetings with delegated entities in accordance with their contract. • Gather data and compile various utilization and quality improvement reports. • Develop and implement Corrective Action Plans. • Recommend changes/enhancements to the Quality Improvement policies and procedures. • Identify best practices, research new processes and recommend program enhancements. • Coordinate QIC activities and monthly meetings. • Oversee the enforcement of contract terms regarding data submission for delegated entities. • Participate in the development of reporting and data outcome reports. • Performs other duties as assigned • Complies with all policies and standards Education/Experience Bachelor’s degree in Nursing preferred. 3+ years of clinical, quality improvement or healthcare experience. 2+ years of experience in quality function in a healthcare setting. License/Certification LPN, LVN, RN, PA, or LCSW license preferred. CPHQ (Certified Professional in Healthcare Quality) preferred. Pay Range $33.03 - $59.47 per hour 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

Manage and coordinate long-term services and supports for members by developing care plans, collaborating with providers, and ensuring compliance with regulations. | Minimum 3 years experience in case management or care coordination with strong knowledge of LTSS programs and proficiency in EHR systems. | Job Title: LTSS Service Care Manager Company Overview: Carolina Complete Health is a leading healthcare organization dedicated to improving the lives of our members through innovative and compassionate care. As part of the Centene family, we serve over 28 million members nationwide, focusing on transforming community health with a commitment to quality and accessibility. Role Overview: As an LTSS Service Care Manager, you will play a pivotal role in managing long-term services and supports for our members. Your work will ensure that individuals receive personalized care plans that promote independence and improve their quality of life. What You'll Do: - You will assess member needs and develop comprehensive care plans tailored to individual requirements. - You will coordinate with healthcare providers, community resources, and families to ensure seamless service delivery. - You will monitor member progress and adjust care plans as necessary to meet evolving needs. - You will advocate for members to access appropriate services and supports. - You will maintain accurate documentation and compliance with regulatory standards. - You will collaborate with interdisciplinary teams to enhance care coordination. - You will provide education and support to members and their caregivers. - You will participate in quality improvement initiatives to enhance service outcomes. What You Bring: - Minimum of 3 years experience in case management or care coordination, preferably in LTSS. - Strong knowledge of long-term services and supports programs and regulations. - Excellent communication and interpersonal skills to engage effectively with members and providers. - Ability to manage multiple cases and prioritize tasks efficiently. - Proficiency with electronic health records and care management software. Bonus Points If You Have: - Certification in Case Management (CCM) or related credentials. - Experience working within Medicaid or Medicare programs. - Background in social work, nursing, or related healthcare fields. - Bilingual abilities to support diverse member populations. What We Offer: - We offer competitive salary and comprehensive benefits including health, dental, and vision coverage. - We offer flexible work arrangements to support work-life balance. - We offer opportunities for professional development and career growth. - We offer a supportive and inclusive work environment committed to diversity. - We offer employee wellness programs and community engagement initiatives. Ready to Apply? To join our team and make a meaningful impact, please submit your resume and cover letter through our online application portal at Carolina Complete Health careers page. We look forward to hearing from you!

Manage and coordinate long-term services and supports for members, ensuring personalized care plans and compliance with regulations. | Minimum 3 years experience in case management or LTSS, strong knowledge of LTSS programs, excellent communication skills, and proficiency with care management software. | Job Title: LTSS Service Care Manager Company Overview: Carolina Complete Health is a leading healthcare organization dedicated to improving the lives of our members through innovative and compassionate care. As part of the Centene family, we serve over 28 million members nationwide, focusing on transforming community health with a commitment to quality and accessibility. Role Overview: As an LTSS Service Care Manager, you will play a pivotal role in managing long-term services and supports for our members. Your work will ensure that individuals receive personalized care plans that promote independence and improve their quality of life. What You'll Do: - You will assess member needs and develop comprehensive care plans tailored to individual requirements. - You will coordinate with healthcare providers, community resources, and families to ensure seamless service delivery. - You will monitor member progress and adjust care plans as necessary to meet changing needs. - You will advocate for members to access appropriate services and supports. - You will maintain accurate and timely documentation in compliance with regulatory standards. - You will collaborate with interdisciplinary teams to enhance care quality and outcomes. - You will educate members and caregivers about available resources and support options. - You will participate in quality improvement initiatives to advance service effectiveness. What You Bring: - Minimum of 3 years experience in case management or care coordination, preferably in LTSS or related healthcare fields. - Strong knowledge of long-term services and supports programs and regulations. - Excellent communication and interpersonal skills to engage effectively with members and providers. - Ability to manage multiple cases and prioritize tasks in a fast-paced environment. - Proficiency with electronic health records and care management software. Bonus Points If You Have: - Certification in Case Management (CCM) or related credentials. - Experience working within Medicaid or Medicare programs. - Background in social work, nursing, or related healthcare disciplines. - Bilingual abilities to support diverse member populations. What We Offer: - We offer competitive salary and comprehensive benefits including health, dental, and vision coverage. - We offer flexible work arrangements to support work-life balance. - We offer opportunities for professional development and career growth. - We offer a supportive and inclusive work environment committed to diversity. - We offer employee wellness programs and community engagement initiatives. Ready to Apply? To join our team and make a meaningful impact, please submit your resume and cover letter through our online application portal at CarolinaCompleteHealth.com/careers.

Manage and coordinate long-term services and supports for members, ensuring personalized care plans and compliance with regulations. | Minimum 3 years experience in case management or LTSS, strong knowledge of LTSS programs, excellent communication skills, and proficiency with care management software. | Job Title: LTSS Service Care Manager Company Overview: Carolina Complete Health is a leading healthcare organization dedicated to improving the lives of our members through innovative and compassionate care. As part of the Centene family, we serve over 28 million members nationwide, focusing on transforming community health with a commitment to quality and accessibility. Role Overview: As an LTSS Service Care Manager, you will play a pivotal role in managing long-term services and supports for our members. Your work will ensure that individuals receive personalized care plans that promote independence and improve their quality of life. What You'll Do: - You will assess member needs and develop comprehensive care plans tailored to individual requirements. - You will coordinate with healthcare providers, community resources, and families to ensure seamless service delivery. - You will monitor member progress and adjust care plans as necessary to meet changing needs. - You will advocate for members to access appropriate services and supports. - You will maintain accurate and timely documentation in compliance with regulatory standards. - You will collaborate with interdisciplinary teams to enhance care quality and outcomes. - You will educate members and caregivers about available resources and support options. - You will participate in quality improvement initiatives to advance service effectiveness. What You Bring: - Minimum of 3 years experience in case management or care coordination, preferably in LTSS or related healthcare fields. - Strong knowledge of long-term services and supports programs and regulations. - Excellent communication and interpersonal skills to engage effectively with members and providers. - Ability to manage multiple cases and prioritize tasks in a fast-paced environment. - Proficiency with electronic health records and care management software. Bonus Points If You Have: - Certification in Case Management (CCM) or related credentials. - Experience working within Medicaid or Medicare programs. - Background in social work, nursing, or related healthcare disciplines. - Bilingual abilities to support diverse member populations. What We Offer: - We offer competitive salary and comprehensive benefits including health, dental, and vision coverage. - We offer flexible work arrangements to support work-life balance. - We offer opportunities for professional development and career growth. - We offer a supportive and inclusive work environment committed to diversity. - We offer employee wellness programs and community engagement initiatives. Ready to Apply? To join our team and make a meaningful impact, please submit your resume and cover letter through our online application portal at CarolinaCompleteHealth.com/careers.

Manage and coordinate long-term services and supports for members, ensuring personalized care plans and compliance with regulations. | Minimum 3 years experience in case management or LTSS, strong knowledge of LTSS programs, excellent communication skills, and proficiency with care management software. | Job Title: LTSS Service Care Manager Company Overview: Carolina Complete Health is a leading healthcare organization dedicated to improving the lives of our members through innovative and compassionate care. As part of the Centene family, we serve over 28 million members nationwide, focusing on transforming community health with a commitment to quality and accessibility. Role Overview: As an LTSS Service Care Manager, you will play a pivotal role in managing long-term services and supports for our members. Your work will ensure that individuals receive personalized care plans that promote independence and improve their quality of life. What You'll Do: - You will assess member needs and develop comprehensive care plans tailored to individual requirements. - You will coordinate with healthcare providers, community resources, and families to ensure seamless service delivery. - You will monitor member progress and adjust care plans as necessary to meet changing needs. - You will advocate for members to access appropriate services and supports. - You will maintain accurate and timely documentation in compliance with regulatory standards. - You will collaborate with interdisciplinary teams to enhance care quality and outcomes. - You will educate members and caregivers about available resources and support options. - You will participate in quality improvement initiatives to advance service effectiveness. What You Bring: - Minimum of 3 years experience in case management or care coordination, preferably in LTSS or related healthcare fields. - Strong knowledge of long-term services and supports programs and regulations. - Excellent communication and interpersonal skills to engage effectively with members and providers. - Ability to manage multiple cases and prioritize tasks in a fast-paced environment. - Proficiency with electronic health records and care management software. Bonus Points If You Have: - Certification in Case Management (CCM) or related credentials. - Experience working within Medicaid or Medicare programs. - Background in social work, nursing, or related healthcare disciplines. - Bilingual abilities to support diverse member populations. What We Offer: - We offer competitive salary and comprehensive benefits including health, dental, and vision coverage. - We offer flexible work arrangements to support work-life balance. - We offer opportunities for professional development and career growth. - We offer a supportive and inclusive work environment committed to diversity. - We offer employee wellness programs and community engagement initiatives. Ready to Apply? To join our team and make a meaningful impact, please submit your resume and cover letter through our online application portal at CarolinaCompleteHealth.com/careers.

Manage and coordinate long-term services and supports for members, ensuring personalized care plans and compliance with regulations. | Minimum 3 years experience in case management or LTSS, strong knowledge of LTSS programs, excellent communication skills, and proficiency with care management software. | Job Title: LTSS Service Care Manager Company Overview: Carolina Complete Health is a leading healthcare organization dedicated to improving the lives of our members through innovative and compassionate care. As part of the Centene family, we serve over 28 million members nationwide, focusing on transforming community health with a commitment to quality and accessibility. Role Overview: As an LTSS Service Care Manager, you will play a pivotal role in managing long-term services and supports for our members. Your work will ensure that individuals receive personalized care plans that promote independence and improve their quality of life. What You'll Do: - You will assess member needs and develop comprehensive care plans tailored to individual requirements. - You will coordinate with healthcare providers, community resources, and families to ensure seamless service delivery. - You will monitor member progress and adjust care plans as necessary to meet changing needs. - You will advocate for members to access appropriate services and supports. - You will maintain accurate and timely documentation in compliance with regulatory standards. - You will collaborate with interdisciplinary teams to enhance care quality and outcomes. - You will educate members and caregivers about available resources and support options. - You will participate in quality improvement initiatives to advance service effectiveness. What You Bring: - Minimum of 3 years experience in case management or care coordination, preferably in LTSS or related healthcare fields. - Strong knowledge of long-term services and supports programs and regulations. - Excellent communication and interpersonal skills to engage effectively with members and providers. - Ability to manage multiple cases and prioritize tasks in a fast-paced environment. - Proficiency with electronic health records and care management software. Bonus Points If You Have: - Certification in Case Management (CCM) or related credentials. - Experience working within Medicaid or Medicare programs. - Background in social work, nursing, or related healthcare disciplines. - Bilingual abilities to support diverse member populations. What We Offer: - We offer competitive salary and comprehensive benefits including health, dental, and vision coverage. - We offer flexible work arrangements to support work-life balance. - We offer opportunities for professional development and career growth. - We offer a supportive and inclusive work environment committed to diversity. - We offer employee wellness programs and community engagement initiatives. Ready to Apply? To join our team and make a meaningful impact, please submit your resume and cover letter through our online application portal at CarolinaCompleteHealth.com/careers.

Manage and coordinate long-term services and supports for members to improve health outcomes and ensure access to necessary care. | Minimum 3 years experience in case management or care coordination with knowledge of LTSS programs and proficiency in EHR systems. | Job Title: LTSS Service Care Manager Company Overview: Carolina Complete Health is a leading healthcare organization dedicated to improving the lives of individuals and families across North Carolina. As part of the Centene family, we are committed to transforming community health through innovative care solutions and compassionate service. Our focus is on delivering high-quality, person-centered care to our 28 million members nationwide. Role Overview: As an LTSS Service Care Manager, you will play a critical role in managing long-term services and supports for our members. Your purpose is to coordinate care plans, ensure access to necessary services, and improve health outcomes by working closely with members, providers, and community resources. What You'll Do: - You will assess member needs and develop individualized care plans tailored to their long-term service requirements. - You will coordinate with healthcare providers, social services, and community organizations to facilitate comprehensive care. - You will monitor member progress and adjust care plans as needed to ensure optimal outcomes. - You will advocate for members to ensure they receive timely and appropriate services. - You will maintain accurate documentation and compliance with regulatory standards. - You will educate members and their families about available resources and support options. - You will collaborate with interdisciplinary teams to address complex care challenges. - You will participate in quality improvement initiatives to enhance service delivery. What You Bring: - Minimum of 3 years experience in case management or care coordination, preferably in LTSS or Medicaid populations. - Strong knowledge of long-term services and supports programs and community resources. - Excellent communication and interpersonal skills to engage effectively with members and providers. - Ability to manage multiple cases and prioritize tasks in a fast-paced environment. - Proficiency with electronic health records and care management software. - Relevant licensure or certification in nursing, social work, or related field is preferred. Bonus Points If You Have: - Experience working within Medicaid managed care organizations. - Bilingual skills, especially Spanish, to better serve diverse populations. - Background in behavioral health or chronic disease management. - Certification in case management (CCM) or care coordination. What We Offer: - We offer competitive salary and comprehensive benefits including health, dental, and vision coverage. - We offer flexible work arrangements to support work-life balance. - We offer opportunities for professional development and career growth. - We offer a supportive and inclusive work environment committed to diversity. - We offer employee wellness programs and community engagement initiatives. Ready to Apply? To join our team and make a meaningful impact, please submit your resume and cover letter through our online application portal at CarolinaCompleteHealth.com/careers. We look forward to hearing from you!