Job Description
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 remote. Candidates must reside in Florida to be
considered for the role, and preference will be given to those from the
Tallahassee to Orlando areas. Hospital and Case Management experience strongly
preferred. Home health experience and utilization management a plus.**
**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 familiescare 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, andor community resources needed to address members unmet needs
- Coordinates and manages as appropriate between the member andor familycaregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
- Monitors care plans service plans andor 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 members goals unmet needs
- May identify problemsbarriers 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 plansservice plans
- May perform telephonic, digital, home andor other site outreach to assess member needs and collaborate with resources
- Collaborates with healthcare providers as appropriate to facilitate member services andor 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 andor facilitates education to members and their familiescaregivers 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 hirespreceptees 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 HirePreceptee 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
- *EducationExperience:** Requires a degree from an accredited school of
nursing or a Bachelors degree in nursing and 4 – 6 years of related
experience.
- *LicenseCertification:**
- RN - Registered Nurse - State Licensure andor Compact State Licensure required
- *Additional Skills:**
- Hospital experience preferred
- Case Management experience preferred
- Home Health experience a plus
- Utilization Management a plus
Pay Range: $72,400.00 - $130,100.00 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
individuals 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
Job Tags
Holiday work, Full time, Flexible hours,