Care Manager II (RN)
Company: Centene Corporation
Location: Stillwater
Posted on: November 20, 2023
Job Description:
You could be the one who changes everything for our 28 million
members as a clinical professional on our Medical Management/Health
Services team. Centene is a diversified, national organization
offering competitive benefits including a fresh perspective on
workplace flexibility. Position Purpose: Perform care management
duties to assess, plan and coordinate all aspects of medical and
supporting services across the continuum of care for select members
to promote quality, cost effective care.
- Assess the member's current health status, resource
utilization, past and present treatment plan and services,
prognosis, short and long term goals, treatment and provider
options
- Utilize assessment skills and discretionary judgment to develop
plan of care based upon assessment with specific objectives, goals
and interventions designed to meet member's needs and promote
desired outcomes
- Coordinate services between Primary Care Physician (PCP),
specialists, medical providers, and non-medical staff as necessary
to meet the complete medical socio economic needs of clients
- Provide patient and provider education
- Facilitate member access to community based services
- Monitor referrals made to community based organizations,
medical care and other services to support the members' overall
care management plan
- Actively participate in integrated team care management
rounds
- Identify related risk management quality concerns and report
these scenarios to the appropriate resources.
- Case load will reflect heavier weighting of complex cases than
Care Manager I, commensurate with experience
- Enter and maintain assessments, authorizations, and pertinent
clinical information into various medical management systems
- Direct care to participating network providers
- Perform duties independently, demonstrating advanced
understanding of complex care management principles.
- Participate in case management committees and work on special
projects related to case management as needed
- For New Hampshire, Massachusetts, & Michigan Complete Health -
home visits required Additional requirements for LHCC (LA) for only
DOJ positions:
- Each position will be the delegated agency's single point of
contact to coordinate the overall CM activities provided to the
target population
- Review and approve the initial and ongoing assessment and care
plan to ensure requirements are met
- Coordinate service request/authorizations with UM and ensure
agreement is aligned between the member, agency, and MCO
- Facilitate member linkages to MCO-based services and programs
in collaboration w/ agency staff
- Assist members and/or agency staff w/ transportation to
healthcare appointments
- Communicate status of member health indicators with agency
staff that can contribute the successful community living of
members
- Participate in weekly rounds w/ agency staff
- Other duties as assigned Education/Experience: Graduate from an
Accredited School of Nursing. Bachelor's degree in Nursing
preferred. 2+ years of clinical nursing experience in a clinical,
acute care, or community setting and 1+ years of case management
experience in a managed care setting. Knowledge of utilization
management principles and healthcare managed care. Experience with
medical decision support tools (i.e. Interqual, NCCN) and
government sponsored managed care programs.
Licenses/Certifications: Current state's RN license. Texas
Requirements: Education/Experience: Graduate from an Accredited
School of Nursing. Bachelor's degree in Nursing preferred. 2+ years
of clinical nursing or case management experience in a clinical,
acute care, managed care or community setting. 2+ years experience
working with people with disabilities and vulnerable populations
who have chronic or complex conditions in a managed care
environment. Experience with medical decision support tools (i.e.
Interqual, NCCN) and government sponsored managed care programs.
Other state specific requirements may apply.
Licenses/Certifications: Current state's RN license. For New
Hampshire Healthy Families: Candidates with active RN license in
good standing in other states than NH, must obtain the NH RN equi
within 90 days of hire. Active driver's license in good standing
preferred. CCM preferred. For Arizona Complete Health - Complete
Care plan: Pediatrics assignments require 2+ years' RN experience
in pediatrics (clinical acute care, community or managed care
setting) and 1+ year experience in care management Obstetrics (OB)
assignments require 2+ years' RN experience in OB (clinical, acute,
community or managed care setting) and 1+ year experience in care
management Licenses/Certifications: Current state's RN license. For
Buckeye Community Health Plan: Education/Experience: Graduate from
an Accredited School of Nursing. Bachelor's degree in Nursing
preferred. 2+ years of clinical nursing experience in a clinical,
acute care, or community setting and 1+ years of case management or
utilization experience in a managed care setting. Knowledge of
utilization management principles and healthcare managed care.
Experience with medical decision support tools (i.e. Interqual,
NCCN) and government sponsored managed care programs.
Licenses/Certifications: Current state's RN license. For Michigan
Complete Health: Licensed registered nurse; licensed nurse
practitioner; licensed physician's assistant. Valid driver's
license required. For North Carolina only: Care Managers, this
individual shall be responsible for conducting all functions and
activities of the care management program and serve as the lead for
each care management teams.
- Must reside in North Carolina
- Must be licensed practitioners
- Must be supervised by an RN, LCSW, or psychologist with
trauma-based experience and training.
- Note: Care Manager for medical services is a NC - Licensed
Registered Nurse in good standing. Care Manager for BH services in
NC - Licensed LCSW in good standing. Behavioral Health (BH)
Managers and Full-Time BH Staff: These individuals shall be
responsible for integrating into the clinical and care management
teams to ensure Member's behavioral health needs are fully
integrated into the service delivery system.
- Must reside in North Carolina
- Experience working in behavioral health managed care and
clinical setting
- Licensed behavioral health professional practicing within their
scope For Sunshine Health (FL) Only: Employees supporting Florida's
Children's Medical Services (CMS) must have a minimum of two years
of pediatric experience. May require up to 80% local travel. For
Shared Services: Clinical licensure for multiple states is
required. For Illinois Youth Care contract: Required
Education/Experience - Bachelor's Degree in nursing and RN
licensure required. Two plus years of clinical experience required.
For Illinois YouthCare plan only: Candidates are required to live
within the specified region. For Oklahoma Complete Health Only:
Registered nurse with a license to practice in the State of
Oklahoma. Must successfully complete the Behavioral Health Case
Manager certification training provided through the Department of
Mental Health and Substance Abuse Services within (6) months of
date of hire. Our Comprehensive Benefits Package: Flexible work
solutions including remote options, hybrid work schedules and dress
flexibility, Competitive pay, Paid time off including holidays,
Health insurance coverage for you and your dependents, 401(k) and
stock purchase plans, Tuition reimbursement and best-in-class
training and development. 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.
Keywords: Centene Corporation, Stillwater , Care Manager II (RN), Executive , Stillwater, Oklahoma
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