6 jobs found in illinois

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Supervisor, Non-Clinical Field Care Management
Centene Corporation Illinois, USA
Jan 20, 2021
Supervises staff, ensures appropriate workload distribution and oversees day to day workflow processes. Ensures team is compliant with all model of care regulatory requirements, and produces optimal clinical, socio economic and resource outcomes. Ensures the case management process of assessing, planning, implementation, coordination, monitoring, and evaluating services and outcomes is pursued to maximize the health of the Member. Oversees the socio economic needs and services of selected member populations across the continuum of illness. Carries an assigned case workload and assumes a leadership role within the interdisciplinary team. Works directly with the member in the field, i.e., inpatient bedside, member's home, provider's office, hospitals, etc. to assess, plan, implement, coordinate, monitor and evaluate services and outcomes to maximize the health of the member. Supervises daily activities of the Field Service Coordination staff ensuring performance standards are...
Medical Director
Centene Corporation Illinois, USA
Jan 20, 2021
Position Purpose : Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services. Supports effective implementation of performance improvement initiatives for capitated providers. Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Assists the Chief Medical Director in the functioning of the physician...