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- Performs an in-depth assessment of the beneficiary's physical, mental, spiritual and social needs
- Develops a collaborative, multidisciplinary plan of care in cooperation with the beneficiary, using motivational interviewing to determine the focus and primary issues
- Performs telephonic follow-up assessments on a regular schedule
- Coordinates services with the health care team to eliminate duplication of service and conserve benefit dollars
- Contacts members of the medical team to discuss the beneficiary's course of progress and needs, clarify diagnosis, prognosis, therapies and activities of daily living
- Contacts family, as appropriate, to check understanding of the beneficiary's diagnosis, prognosis and ability to provide caregiver support.
- Identifies problems, anticipates complications and acts to avoid them
- Provides health instruction to the beneficiary/family
- Refers beneficiary to providers or other healthcare team members as needed
- Discusses advanced care planning with beneficiaries
- Documents case summary based on information received and communicates with the beneficiary and involved providers
- Facilitates transfer of beneficiary throughout the different regions and within the region by collaborating with the military liaison to transition the beneficiary with minimal disruption of their health care services
- Coordinates the basic benefit and identifies and submits benefit modifications as appropriate or submits a request to TRICARE Health Plan/Department of Health Affairs for benefit exceptions/special programs
- Assesses the benefit plan for coverage and limitations and provides education to the beneficiary.
- Negotiates for cost-effective rates for provider services which includes: Contacts multiple providers for a rate comparison of home health care services and identification of the most cost-effective approach; Suggests medically appropriate alternatives to accomplish treatment plan goals more cost effectively.
- Identifies financial distress and refers beneficiary/family to staff social worker and/or community resources
- Provides list of resources with qualified providers who can assist with problems arising from illness/injury
- Conducts a telephonic post-discharge assessment within 48 hours of discharge to assure proper support and services are in place to make a full recovery (i.e. equipment, home health and other services, transportation, etc.)
- Contacts members of the medical team to discuss the beneficiary's course of progress and needs utilizing available discharge information
- Ensures beneficiary effectively navigates the health care system
- Evaluates referrals for type, accuracy and timeframes and provides assistance as needed
- Assess beneficiary's condition and understanding of their injury and their ability to follow the treatment plan
- Works with physicians and hospitals to enforce treatment plans and orders, ensures beneficiaries receive specialty care and tests when ordered
Case Manager II - Remote-PA, United States - Centene Corporation
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.
Physical Health Case Manager II:
Graduate of Accredited Nursing Program, BSN Degree preferred: Five years clinical experience in a health care environment required
Two years proven case management experience required
Managed care experience preferred
TRICARE experience preferred
Behavioral Health Case Manager II:
Graduate of Accredited Master Level Psychology, Counseling or Social Work Program or Accredited Nursing Program, BSN preferred.: Five years clinical experience in a health care environment required
Two years proven case management experience required
Managed care experience preferred
TRICARE experience preferred
License/Certification:
Physical Health Case Manager II: Valid, Current, Active Registered Nurse License
Behavioral Health Case Manager II: Clinical Psychologist, Marriage Family Therapist, Professional Counselor, Mental Health Counselor or Clinical Social Worker licensed to practice independently in the State where they reside or Registered Nurse. Ability to obtain additional State(s) licensure may be required. License must be valid, current and active.
Both Physical and Behavioral Health Case Manager II roles must have certification in case management with one of the following certifications:
Accredited Case Manager (ACM):
Case Management Administrator, Certified (CMAC):
Case Management Certified (CMC):
Certified Case Manager (CCM): Registered Nurse Case Manager (RN-CM)
Registered Nurse Board Certified (RN-BC)
Must have and maintain a current, valid, active and unrestricted clinical license.
This is a remote telephonic position. License must be valid for the state where you reside and perform your job duties.
Government Security/Clearance/US Citizenship Requirements: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 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.