Centene Corporation Care Manager II-RN (Remote) South Bend,IN in South Bend, Indiana

Description:

PositionPurpose: Perform care management duties to assess, plan and coordinate allaspects of medical and supporting services across the continuum of care forselect members to promote quality, cost effective care.

  • Assess the member's current health status, resource utilization, pastand 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 carebased upon assessment with specific objectives, goals and interventionsdesigned to meet member's needs and promote desired outcomes
  • Coordinate services between Primary Care Physician (PCP), specialists,medical providers, and non-medical staff as necessary to meet the completemedical 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 careand other services to support the members overall care management plan
  • Actively participate in integrated team care management rounds
  • Identify related risk management quality concerns and report thesescenarios to the appropriate resources
  • Case load will reflect heavier weighting of complex cases than CareManager I, commensurate with experience
  • Enter and maintain assessments, authorizations, and pertinent clinicalinformation into various medical management systems
  • Direct care to participating network providers
  • Perform duties independently, demonstrating advanced understanding ofcomplex care management principles
  • Participate in case management committees andwork on special projects related to case management as needed

Qualifications:

Education/Experience: Graduatefrom an Accredited School of Nursing. Bachelor s degree in Nursing preferred.2 years of clinical nursing experience in a clinical, acute care, or communitysetting and 1 years of case management experience in a managed care setting. Knowledgeof utilization management principles and healthcare managed care. Experiencewith medical decision support tools (i.e. Interqual, NCCN) and governmentsponsored managed care programs.

Licenses/Certifications: Current state s RNlicense.

Alabama Requirements:

Education/Experience: Bachelor s degree inNursing. 2 years of clinical nursing experience in a clinical, acute care, orcommunity setting and 1 years of case management experience in a managed caresetting. Knowledge of utilization management principles and healthcare managedcare. Experience with medical decision support tools (i.e. Interqual, NCCN) andgovernment sponsored managed care programs.

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Licenses/Certifications: Current state s RNlicense.

Centene is an equal opportunity employer that is committed todiversity, and values the ways in which we are different. All qualifiedapplicants 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 applicablelaw.

Job: Clinical & Nursing

Organization: Managed Health Services IN

Location: Indiana-South Bend

Requisition ID: 0087M