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.
Responsibilities
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 and/or facilitates the plan for the best outcome.
Develops ongoing care plans/service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs.
Identifies problems/barriers to care and provides appropriate care management interventions.
Coordinates as appropriate between the member and/or family/caregivers 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 toward care plan/service plan goals; collaborates with member, caregivers, and appropriate providers to revise or update care plan/service plan as necessary to meet the member's 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.
Facilitates care management and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services.
May perform telephonic, digital, home and/or 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 and/or facilitates education to members and their families/caregivers 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.
Education & Experience
Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2–4 years of related experience.
License/Certification: RN – Registered Nurse – State Licensure and/or Compact State Licensure required.
Travel & Location
This role is a hybrid position and requires approximately 75% travel for member home visits within Wayne and Macomb counties, MI.
Compensation
Pay Range $55,100.00 – $99,000.00 per year.
Benefits
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.
Equal Opportunity
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.