Care Coordinator IV

Centene Corporation•Remote-NC, NC

12d

About The Position

The Care Coordinator IV leads care coordination activities for assigned members, supporting care management and ensuring appropriate services are delivered by providers and continuity of care is maintained across services. The role is part of the Pediatric Care Management team and focuses on pediatric members from birth through age five. The position serves as a liaison among members, care managers, providers, and community partners, with member outreach conducted by telephone or home visits. Candidates must reside in North Carolina. The role follows a standard schedule; flexible scheduling may be available after hire and completion of training. The position includes engaging members and discussing care plans or service plans, coordinating activities with healthcare and community providers and members or caregivers, and providing support for complex member or provider inquiries. It also involves documenting and reviewing member records in accordance with applicable state and regulatory requirements, helping triage and escalate complex requests, identifying needs and making referrals, and providing education about benefits and available resources. The role may oversee assessments and screenings for members with complex needs and may assist with training and development. Other duties may be assigned, and the employee must comply with all policies and standards.

Requirements

High school diploma or GED.
At least 4 years of related experience.
Must reside in North Carolina.

Responsibilities

Lead and oversee member outreach by phone or home visits to discuss care plans or service plans, next steps, resources, questions, concerns, and ongoing education.
Coordinate care activities based on care plans or service plans, working with healthcare and community providers, partners, members, and caregivers as needed.
Provide support and insight for complex member and provider inquiries, requests, or concerns related to care plans or service plans.
Develop advanced knowledge of care management services and respond to some complex or escalated issues.
Communicate with care managers, practitioners, and others to facilitate member services and continuity of care.
May oversee service assessments and screenings for members with complex needs and document member care needs.
Document, maintain, and review member records in accordance with state and regulatory requirements, and provide records to providers as needed.
Work with the care management team to triage, adjust, and escalate highly complex requests to management.
Follow standards of practice and policies that comply with contractual requirements and regulatory guidelines and standards.
Identify needs and make referrals to Care Managers, community-based organizations, and Disease Managers.
Provide education about available benefits and resources.
May assist with training and development needs.
Perform other duties as assigned and comply with all policies and standards.