Pediatric Care Manager (RN) - Remote/Field, Bonus Eligible
Company: Superior HealthPlan
Posted on: January 12, 2022
You could be the one who changes everything for our 25 million
members. Centene is transforming the health of our communities, one
person at a time. As a diversified, multi-national organization,
you'll have access to competitive benefits including a fresh
perspective on workplace flexibility.
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
Coordinate services between Primary Care Physician (PCP),
specialists, medical providers, and non-medical 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
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
For New Hampshire, Massachusetts, & Michigan Complete Health - home
Our Comprehensive Benefits Package:
Flexible work solutions including remote options, hybrid work
schedules and dress flexibility
Paid Time Off including paid holidays
Health insurance coverage for you and dependents
401(k) and stock purchase plans
Tuition reimbursement and best-in-class training and
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
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.
Keywords: Superior HealthPlan, Allen , Pediatric Care Manager (RN) - Remote/Field, Bonus Eligible, Executive , Allen, Texas
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