Senior Care Navigator - Pediatric

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 position is a full time hybrid role, hours are Tuesday - Saturday 8-5pm

Must reside in Orange, Seminole, Osceola or Brevard County for face to face visits with members.

Position Purpose: Assesses, plans, implements, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.

This position is a full time hybrid role, hours are Tuesday - Saturday 8-5pm

Must reside in Orange, Seminole, Osceola or Brevard County for face to face visits with members.

• Develops or contributes to the development of ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care
• Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members in a timely manner
• May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate
• Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans
• Identifies problems/barriers for care coordination and appropriate care management interventions for members with higher level of care needs
• Reviews referrals information and intake assessments to develop or assist in the development of appropriate care plan/service plan for members with higher level of care needs
• Collaborates with healthcare partners as appropriate to facilitate member care to ensure member needs are met and determine if care plan/service plan revision is needed
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
• May perform on-site visits to assess member’s needs and collaborate with providers or resources, as appropriate
• May provide education to care managers and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits
• Serves as a Subject Matter Expert (SME) to support the care navigation team and/or serve as a preceptor for newly hired staff
• Other duties or responsibilities as assigned by people leader to meet the member and/or business needs
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience: Requires a Bachelor’s degree and 4 – 6 years of related experience.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

License/Certification:

• Current state’s clinical license preferred
• For CMS Florida licensed practical nurse with a minimum of four years of pediatric experience, or a Master’s degree in social work with a minimum of one year of related professional pediatric care experience. May require up to 80% local travel required

This position is a full time hybrid role, hours are Tuesday - Saturday 8-5pm

Must reside in Orange, Seminole, Osceola or Brevard County for face to face visits with members.

Pay Range: $26.50 - $47.59 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 equa