Senior Care Manager (RN)

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 knowledge, experience 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

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

Case load will reflect heavier weighting of complex cases than Care Manager II, commensurate with experience

Serve as a subject matter expert for questions or issues for other Utilization Review and Care Managers, Referral Specialists and Program Coordinators

Audit case reviews to ensure compliance with case management policies and procedures and NCQA requirements

Assist with the development of case management workflows, policies, and procedures

Provide oversight to and assist with training of other case management staff

For New Hampshire and Massachusetts - home visits required

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 3 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. URAC Recognized Care Management Certification must be obtained within 6 months of hire.

For New Hampshire and Massachusetts - must obtain current state's RN license within 90 days of hire. Valid driver's 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. 3 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.

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.