Senior Care Manager RN at Centene assessing and implementing complex care management activities and developing personalized care plans for healthcare outcomes. The role includes educating members and managing care services with approximately 75% travel.
Responsibilities
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 families/care 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, and/or community resources needed to address member's unmet needs
Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care of services
Monitors care plans / service plans and/or 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 member's goals / unmet needs
May identify problems/barriers 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
Performs telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
Requirements
Requires a Degree from an Accredited School or Nursing or a Bachelor's degree in Nursing and 4 – 6 years of related experience
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Benefits
competitive pay
health insurance
401K and stock purchase plans
tuition reimbursement
paid time off plus holidays
flexible approach to work with remote, hybrid, field or office work schedules
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