Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.

Position Purpose:

In partnership with the CMO, serve as a key stakeholder, decision maker, and catalyst, for all market level population health identification, strategy, evaluation, and monitoring to achieve the Quadruple Aim and drive Centene's Population Health mission at the market level.

“Sunshine Health is recruiting an experienced clinical professional to lead the Children’s Health Care Management Organization based in Florida.

Oversee and direct all clinical operations, including care management and coordination, and utilization management. The Vice President of Children’s Health-Care Management will be directly responsible for leading approximately 1,400 Care Managers located across the state of Florida.

Candidates must have an active clinical license, experience leading large teams, solid understanding of Medicaid compliance requirements, and a proven record of implementing innovative initiatives with positive health outcomes. Must reside in state of Florida presenting (or be willing to relocate within the next 6 months) and pass AHCA Level II background screening. This is a remote position with up to 50% travel across state of FL.

Teams reporting to the VP of Children’s health will work remotely but must be accessible for meetings across the state of FL.

Implementation of successful health outcomes initiatives, oversight of care coordination activities for pediatric members, and supporting the health of Sunshine Health’s State Medicaid Managed Care and Children’s Medical Services populations."

Responsibilities:

• Strategic

• Provide strategic leadership for population health internally, as well as with providers, community organizations, advocacy groups, and applicable legislature
• Understand the local healthcare landscape to look for key drivers & opportunities for innovative models targeting the Quadruple Aim
• Understand the unique community health needs and the attributes of the populations served to drive development of programs and service
• Uses analytics to identify key insights about the populations served and drive the development of the interventions to target unique populations

• Leadership

• Oversees performance of all UM functions (prior authorization, concurrent review) for the market per the defined partnership agreement
• Orchestrates all elements of the population health strategy for the business•Drives HBR initiatives locally through strong partnership and routine with Finance
• Partners with MDs to translate the needs of the members into intentional clinical program design that delivers successful health outcomes
• Liaises with state regulators for clinical programs
• Coordinates quality initiatives (audits, star ratings, contract reviews, etc) and activate enterprise and local policies
• Informs and executes against contracts (including provider contracts) – driving outcomes captured in contract and operationalizing locally
• Contributing member of enterprise and local committees
• Serves as an integral member of the executive leadership team, charged with delivering clinical solutions to evolving business needs
• Executes on standards and customizing per local requirements while partnering with the COEs to drive continuous improvement through governance and performance monitoring
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:

Bachelor's degree with 5+ years of relevant experience.

Previous experience in a managed care organization strongly preferred.

3+ of leadership experience. Master's Degree preferred.

License/Certification: Current state RN license preferred.

PA Plan Only: State license required within 90 days of hire.

Fidelis Care Plan Only: Bachelor’s degree in healthcare administration or related field required; master’s degree preferred.

For Illinois Plan Only: This position shall be a licensed Physician, licensed registered nurse, or other professional as approved by the Department based on Contractor’s ability to demonstrate that the professional possesses the training and education necessary to meet the requirements for Case Management and Disease Management Program activities required in the Contract. Must reside in Illinois. Will direct all activities pertaining to Case Management and Care Coordination activities and monitor utilization of Enrollees’ physical health and behavioral health. Will be responsible for all population health and related issues, including population health activities and coordination between Behavioral Health services.

Michigan Health Plan: Master's degree or other advanced degree in nursing, social work, health services research, health policy, information technology or other relevant field required.

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. Total compensation may also include additional forms of incentives.

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