Centene Corporation
Care Manager (RN) (CA Only)
Centene Corporation, Los Angeles, California, United States, 90079
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 outcomeDevelops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needsIdentifies problems/barriers to care and provide appropriate care management interventionsCoordinates 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 servicesProvides 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 needsProvides 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 appropriateFacilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or servicesMay perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resourcesCollects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulatorsProvides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefitsProvides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective mannerOther duties or responsibilities as assigned by people leader to meet business needsPerforms other duties as assignedComplies with all policies and standardsEducation/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
#J-18808-Ljbffr
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 outcomeDevelops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needsIdentifies problems/barriers to care and provide appropriate care management interventionsCoordinates 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 servicesProvides 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 needsProvides 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 appropriateFacilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or servicesMay perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resourcesCollects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulatorsProvides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefitsProvides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective mannerOther duties or responsibilities as assigned by people leader to meet business needsPerforms other duties as assignedComplies with all policies and standardsEducation/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
#J-18808-Ljbffr