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.
Hybrid Position - Remote with field visits
Must be licensed and reside in in the state of Texas
Service Delivery Area: Edinburg TX area
Position Purpose:
Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care plan / service plan for long-term care members, addresses issues, and educates members and their families/caregivers on services and benefit options available to receive appropriate high-quality care.
Evaluates the service needs of the most complex or high risk/high acuity members and recommends a plan for the best outcomeDevelops and continuously assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed to address member's needsCoordinates 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 or servicesMonitors 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 / needsMonitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicableReviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulationsReviews referrals information and intake assessments to develop appropriate care plans / service plansCollaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if neededCollects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and clinical guidelinesProvides and/or facilitates education to long-term care members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefitsActs as liaison and member advocate between the member/family, physician, and facilities/agenciesEducates on and coordinates community resources. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living)May perform home and/or other site visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as requiredPartners with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective mannerMay precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readinessMay provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practiceMay engage and assist New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination successEngages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readinessPerforms other duties as assignedComplies with all policies and standards
Education/Experience: Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 4–6 years of related experience
Bachelor's degree in Nursing preferred
License/Certification:
RN - Registered Nurse - State Licensure and/or Compact State Licensure required orNP - Nurse Practitioner - Current State's Nurse Licensure requiredFor Superior: Resource Utilization Group (RUG) certification must be obtained within 90 days of hire required
Pay Range: $34.81 - $62.54 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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act