Job Description
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.
### **This is a remotework-from-home opportunity with local travel required
for member visits. Candidates should reside in one of the following counties
in Florida to be considered for this role: Baker, Nassau, Duval, Clay, St.
Johns, Flagler, or Volusia Two years of pediatric experience is required.**
**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 andor facilitates the plan for the best outcome
- Develops ongoing care plans service plans and collaborates with providers to identify providers, specialists, andor community resources to address members unmet needs
- Identifies problemsbarriers to care and provide appropriate care management interventions
- Coordinates as appropriate between the member andor familycaregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
- Provides 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 members goals unmet needs
- Provides 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 appropriate
- Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services
- May perform telephonic, digital, home andor other site outreach to assess member needs and collaborate with resources
- Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
- Provides andor facilitates education to members and their familiescaregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
- Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
- Other duties or responsibilities as assigned by people leader to meet business needs
- Performs other duties as assigned
- Complies with all policies and standards
- *EducationExperience:** Requires a Degree from an Accredited School of
Nursing or a Bachelors degree in Nursing and 2 – 4 years of related
experience.
- *LicenseCertification:**
- RN - Registered Nurse - State Licensure andor Compact State Licensure required
- **For Sunshine Health (FL) Only:** Employees supporting Floridas Children’s Medical Services (CMS) must have a minimum of two years of pediatric experience.
Pay Range: $54,000.00 - $97,100.00 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
individuals 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
Job Tags
Holiday work, Full time, Local area, Remote job, Flexible hours,