Vice President, Medicare Care Management

Lead the national Medicare Care Management organization, including regional operations, transitions of care, complex care management, duals care management, and specialty programs.

Develop and execute the enterprise care management strategy to improve clinical outcomes, member experience, Star Ratings, and medical cost performance.

Align care management programs with Medicare Advantage growth, quality, utilization management, LTSS, and value-based care strategies.

Partner with executive leadership to establish priorities, performance goals, and multi-year transformation roadmaps.

Accountable for Model of Care (MOC) performance, compliance, audit readiness, and regulatory outcomes.

Drive operational excellence through standardized workflows, consistent clinical practices, and performance management across markets.

Lead continuous improvement efforts focused on reducing unnecessary variation and improving member outcomes.

Ensure care management programs demonstrate measurable impact on quality, utilization, member engagement, and total cost of care.

Develop and oversee programs supporting transitions of care, complex care management, chronic condition management, behavioral health integration, and duals populations.

Identify and implement opportunities to reduce avoidable admissions, readmissions, emergency department utilization, and post-acute care costs.

Partner closely with Utilization Management, Medical Economics, Network, Pharmacy, and Quality leaders to deliver annual QAI and affordability targets.

Translate clinical insights into scalable interventions that improve health outcomes while managing medical expense.

Lead modernization of care management capabilities through workflow automation, digital engagement, AI-enabled clinical support, and analytics.

Partner with technology teams to improve clinical platforms, reporting, interoperability, and workforce productivity.

Drive adoption of data-driven decision making and advanced member targeting strategies.

Champion innovation that enhances both member outcomes and operational efficiency.

Build and develop a high-performing team of regional and functional leaders.

Establish a culture of accountability, collaboration, transparency, and continuous improvement.

Lead succession planning, workforce strategy, organizational design, and talent development initiatives.

Foster strong partnerships across Compliance, Operations, Quality, Medical Affairs, and Health Plan leadership.

Key Experience Requirements

Bachelor's Degree with 5+ years of relevant experience required.

Master's Degree preferred.

Preferred:

Significant responsibility for Medicare Advantage Care Management operations.

Deep expertise in Model of Care requirements, CMS regulations, NCQA standards, and audit readiness.

Demonstrated success improving clinical outcomes, STAR performance, member experience, and medical cost trends.

Experience leading large, geographically dispersed teams through transformational change

Proven ability to influence executive stakeholders and drive enterprise-wide initiatives across multiple functions

Current state RN license preferred.

Pay Range: $188,900.00 - $359,800.00 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