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Care Manager (RN) (CA Only)

Centene Corporation • Sacramento, CA 94278 • Posted 22 days ago

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Hybrid • Full-time • $25.97-$46.68/hr • Mid Level

Job Highlights

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The Care Manager (RN) at Centene Corporation is responsible for developing, assessing, and facilitating complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes. This includes personalized care plans and education for members and their families. The role involves evaluating member needs, developing care plans, coordinating care, and providing education and support.

Responsibilities

  • Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome
  • Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs
  • Identifies problems/barriers to care and provide appropriate care management interventions
  • Coordinates between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
  • Provides ongoing follow up and monitoring of 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
  • Provides resource support to members and care managers for local resources for various services based on service assessment and plans, as appropriate
  • Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services
  • May perform 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
  • Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner

Qualifications

Required

  • Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing
  • 2 - 4 years of related experience
  • Current state's Registered Nurse (RN) license

About Centene Corporation

Centene Corporation is a leading healthcare enterprise in the United States, specializing in managed healthcare products and services primarily through Medicaid, Medicare, and commercial products. They offer healthcare coverage through managed care plans that include medical, behavioral, and specialty services, aiming to improve health outcomes for underserved populations. Operating on a global scale, Centene has a significant presence in over 30 states and continues to grow through strategic expansions and partnerships, such as acquiring WellCare Health Plans in 2020.

Full 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.

**Position Purpose:** Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.

+ Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome

+ Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs

+ Identifies problems/barriers to care and provide appropriate care management interventions

+ Coordinates 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 or services

+ Provides ongoing follow up and monitoring of 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

+ Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate

+ Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services

+ May perform 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

+ Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner

+ Other duties or responsibilities as assigned by people leader to meet business needs

+ Performs other duties as assigned

+ Complies with all policies and standards

**Education/Experience:** Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 - 4 years of related experience.

**License/Certification:**

+ Current state's Registered Nurse (RN) license required

Pay Range: $25.97 - $46.68 per hour

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.

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.