Care Manager RN - Pediatrics - Now Hiring
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.
Must be licensed and reside in TexasHybrid Position - SDA Travis CountyPosition 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 optionsUtilize 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 outcomesCoordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clientsProvide patient and provider educationFacilitate member access to community based servicesMonitor referrals made to community based organizations, medical care and other services to support the members' overall care management planActively participate in integrated team care management roundsIdentify 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 experienceEnter and maintain assessments, authorizations, and pertinent clinical information into various medical management systemsDirect care to participating network providersPerform 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 neededEach position will be the delegated agency's single point of contact to coordinate the overall CM activities provided to the target populationReview and approve the initial and ongoing assessment and care plan to ensure requirements are metCoordinate service request/authorizations with UM and ensure agreement is aligned between the member, agency, and MCOFacilitate member linkages to MCO-based services and programs in collaboration w/ agency staffAssist members and/or agency staff w/ transportation to healthcare appointmentsCommunicate status of member health indicators with agency staff that can contribute the successful community living of membersParticipate in weekly rounds w/ agency staffOther duties as assignedEducation/
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.
Pay Range:
$66,100.
00 - $118,900.
00 per yearOur 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 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.
Salary:
$66,100.
00 - $118,900.
00 per year.
Estimated Salary: $20 to $28 per hour based on qualifications.
Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Must be licensed and reside in TexasHybrid Position - SDA Travis CountyPosition 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 optionsUtilize 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 outcomesCoordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clientsProvide patient and provider educationFacilitate member access to community based servicesMonitor referrals made to community based organizations, medical care and other services to support the members' overall care management planActively participate in integrated team care management roundsIdentify 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 experienceEnter and maintain assessments, authorizations, and pertinent clinical information into various medical management systemsDirect care to participating network providersPerform 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 neededEach position will be the delegated agency's single point of contact to coordinate the overall CM activities provided to the target populationReview and approve the initial and ongoing assessment and care plan to ensure requirements are metCoordinate service request/authorizations with UM and ensure agreement is aligned between the member, agency, and MCOFacilitate member linkages to MCO-based services and programs in collaboration w/ agency staffAssist members and/or agency staff w/ transportation to healthcare appointmentsCommunicate status of member health indicators with agency staff that can contribute the successful community living of membersParticipate in weekly rounds w/ agency staffOther duties as assignedEducation/
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.
Pay Range:
$66,100.
00 - $118,900.
00 per yearOur 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 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.
Salary:
$66,100.
00 - $118,900.
00 per year.
Estimated Salary: $20 to $28 per hour based on qualifications.
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