Care Manager Ii - Austin, United States - Superior HealthPlan

Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team.

Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

STAR+PLUS Nursing Facility team

Care Manager II (RN) meet with members in their homes, residential living facilities, or in-patient nursing facilities to provide case management and service coordination.

NOTE:

Travel is required to Austin, TX or the surrounding counties: Bastrop, Caldwell, Hays, Lee, Travis, or Williamson County, TX.

Position Purpose:

Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.

• Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
• Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
• Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and nonmedical staff as necessary to meet the complete medical socio economic needs of clients
• Provide patient and provider education
• Facilitate member access to community based services
• Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan
• Actively participate in integrated team care management rounds
• Identify related risk management quality concerns and report these scenarios to the appropriate resources.
• Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience
• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
• Direct care to participating network providers
• Perform duties independently, demonstrating advanced understanding of complex care management principles.
• Participate in case management committees and work on special projects related to case management as needed
• Travel is required to assigned service delivery area(s)

Education/Experience:
Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred.

2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting.

Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.


Licenses/Certifications:
Current state's RN license.


Texas Requirements:


Education/Experience:
Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing or case management experience in a clinical, acute care, managed care or community setting.

2+ years experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment.

Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs. Other state specific requirements may apply.


Licenses/Certifications:
Current state's RN license and active driver's license is required





NOTE:
Work from home and TRAVEL is required to conduct member assessments

Preferred Experience:

• 2+ years of clinical nursing experience/direct patient care and conducting headtotoe assessments for medical/behavioral health conditions among adults (18 and older), and/or 65+ patients with complex medical and fragile conditions.
• 2+ years working in any of the following settings: Long Term Services and Support (LTSS), Long Term Care, Acute Care, ER, ICU, Med/Surg, OR, Telemetry, Home Health, Assisted Living Facilities, Skilled Nursing Facilities, Nursing Rehab, or Women's Health settings.
• 2+ years of experience working in direct RN case management and service coordination in managed care, serving Medicaid or Medicare recipients is preferred.

Pay Range:
$67, $121,300.00 per year

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 differen