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You could be the one who changes everything for our 26 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.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 careDevelop, assess and adjust, as necessary, the care plan and promote desired outcomeAssess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider optionsCoordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clientsDevelop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needsProvide patient and provider educationFacilitate member access to community based servicesMonitor referrals made to community based organizations, medical care and other services to support the members’ overall care management planActively participate in integrated team care management roundsIdentify related risk management quality concerns and report these scenarios to the appropriate resourcesEnter and maintain assessments, authorizations, and pertinent clinical information into various medical management systemsFor LTSS - 30% travel to perform home visits to membersFor New Hampshire and Massachusetts - home visits requiredEducation/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. Knowledge of healthcare and managed care preferred.Licenses/Certifications: Current state’s RN license.For New Hampshire and Massachusetts: Candidates with RN license in good standing in other states than NH, must obtain a NH RN within 90 days of hire. Active driver’s license in good standing preferred.For Arizona Complete Health - Complete Care Plan:
Obstetrics (OB) assignments requires RN experience in OB (clinical, acute care, community)
Pediatric assignments require RN experience in pediatrics (clinical, acute care, community)For Michigan Complete Health: Licensed RN; licensed nurse practitioner, licensed physician's assistant. Valid driver's license required.LTSS Requirements:
Valid driver’s license and proof of car insurance.For North Carolina only: Care Managers, this individual shall be responsible for conducting all functions and activities of the care management program and serve as the lead for each care management teams.
Must reside in North Carolina
Must be licensed practitioners
Must be supervised by an RN, LCSW, or psychologist with trauma-based experience and training.
Note: Care Manager for medical services is a NC - Licensed Registered Nurse in good standing. Care Manager for BH services in NC - Licensed LCSW in good standing.Behavioral Health (BH) Managers and Full-Time BH Staff: These individuals shall be responsible for integrating into the clinical and care management teams to ensure Member’s behavioral health needs are fully integrated into the service delivery system.
Must reside in North Carolina
Experience working in behavioral health managed care and clinical setting
Licensed behavioral health professional practicing within their scopeFor Sunshine Health (FL) Only: Employees supporting Florida's Children’s Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local travel.For Oklahoma Complete Health Only: Employees may be required to be on call. Employees will be required to make member visits.For Shared Services: Clinical licensure for multiple states is requiredFor Illinois Youth Care contract: Required Education/Experience – Bachelor’s Degree in nursing and RN licensure required. One year of clinical experience required.Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.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.TITLE: Care Manager I (RN)LOCATION: Various, MississippiREQNUMBER: 1348592
