Senior Care Manager (RN)

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.
 

This is a remote position open to candidates in South FL Miami to Ft. Lauderdale.

Position Purpose: Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care.

• Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs.
• Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services.
• Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs.
• May identify problems/barriers for care management and appropriate care management interventions for escalated cases.
• Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations.
• Reviews referrals information and intake assessments to develop appropriate care plans/service plans.
• May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources.
• Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed.
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.
• Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits.
• Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner.
• May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness. ​
• Provides guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice​.
• Engages and assists New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success.
• Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
• Other duties or responsibilities as assigned by people leader to meet business needs.
• Performs other duties as assigned.
• Complies with all policies and standards.
• Spanish speaking a plus

  

Education/Experience: Requires a Degree from an Accredited School or Nursing or a bachelor’s degree in nursing and 4 – 6 years of related experience.

License/Certification:

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay Range: $73,800.00 - $132,700.00 per year

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