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About the Role

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 personalized care plans, addresses issues, and educates members and their families/caregivers on available services and benefit options.

Responsibilities

• Evaluates service needs of complex or high risk/high acuity members and recommends a plan for the best outcome.
• Develops and continuously assesses long-term care plans and collaborates with the care management team to identify necessary providers, specialists, and community resources.
• Coordinates and manages care between the member/family/caregivers and the care provider team to ensure adequate and appropriate person-centered care.
• Monitors care plans and member status, including changes in condition and progress towards goals, revising plans as necessary.
• Monitors member status for complications, clinical symptoms, or other changes, assessing needs for higher levels of care or waiver eligibility.
• Reviews member data to identify trends and improve operating performance and quality of care.
• Reviews referral information and intake assessments to develop appropriate care plans.
• Collaborates with healthcare providers to facilitate member services and treatments, revising care plans if needed.
• Collects, documents, and maintains member information and care management activities to ensure compliance.
• Provides and/or facilitates education to members and their families/caregivers on disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits.
• Acts as a liaison and member advocate between the member/family, physician, and facilities/agencies.
• Educates on and coordinates community resources.
• Provides coordination of service authorization for various services based on service assessment and plans.
• May perform home and/or other site visits to assess member needs and collaborate with resources.
• Partners with the leadership team to improve and enhance the quality of care and service delivery in a cost-effective manner.
• May precept clinical new hires by fostering core skills, coaching, and guiding them through the onboarding process.
• May provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO).
• May engage and assist new hires/preceptees during their onboarding journey, including completing competency checkpoints.
• Engages in a collaborative process with People Leaders and cross-functional teams to measure and monitor readiness.
• Performs other duties as assigned.
• Complies with all policies and standards.

Requirements

• Graduate from an Accredited School of Nursing or a Bachelor's degree and 4–6 years of related experience.
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required.
• NP - Nurse Practitioner - Current State's Nurse Licensure required.
• Resource Utilization Group (RUG) certification must be obtained within 90 days of hire required.

Skills

• Care management
• Medical and supporting services coordination
• Care plan development
• Member and family education
• Service authorization coordination
• Community resource coordination
• Clinical assessment
• Collaboration with healthcare providers
• Data review and analysis
• Compliance with state and federal regulations
• Liaison and advocacy
• Precepting clinical new hires
• Coaching and shadowing

Location

• Bell counties
• Brazos counties

Work Type

• Hybrid
• In-person assessments

Experience Level

• 4-6 years of related experience

Education Level

• Graduate from an Accredited School of Nursing
• Bachelor's degree
• Bachelor's degree in Nursing preferred

Salary/Compensations

• $36.21 - $65.09 per hour

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work

About the Company

• At Centene, we connect people to the care they need to live healthier lives.
• You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective.
• It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Equal Opportunity

• 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.