Care Manager (RN)

Centene Corporation•Remote-NJ, NJ

1d•$56,200 - $101,000•Remote

About The Position

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. This primarily remote position follows a Monday–Friday schedule from 9:00 a.m. to 5:00 p.m. and requires up to 50% field-based travel throughout Essex and Union counties in New Jersey. Candidates should reside in one of these counties. Field visits may take place at members’ residences, nursing facilities, medical day care programs, or other service locations, with occasional in-person trainings or meetings at the Iselin, New Jersey office. The role manages a high-volume caseload of Medicaid members with complex health and social needs and requires effective organization, independent work, interdisciplinary collaboration, and proficiency with Microsoft Excel, Outlook, and Teams.

Requirements

Degree from an accredited school of nursing or a bachelor's degree in nursing.
2–4 years of related experience.
Required Registered Nurse (RN) state licensure and/or compact state licensure.
Reside in Essex or Union County, New Jersey, to be considered.
Effective organization, ability to work independently, and interdisciplinary collaboration skills.
Proficiency with Microsoft Excel, Outlook, and Teams.

Responsibilities

Evaluate member needs and barriers to appropriate care, assess social determinants of health, prioritize needs identified by the member, and recommend or facilitate plans for the best outcomes.
Develop ongoing care plans or service plans and collaborate with providers to identify providers, specialists, and community resources to address unmet needs.
Identify problems and barriers to care and provide appropriate care management interventions.
Coordinate between members or their families and caregivers and care provider teams to ensure members receive adequate, appropriate, person-centered care or services.
Follow up and monitor member status, changes in condition, and progress toward care plan or service plan goals; collaborate with members, caregivers, and providers to revise plans as necessary.
Provide resource support to members and care managers for local services, including employment, housing, participant direction, independent living, justice, and foster care resources, as appropriate.
Facilitate care management and collaborate with providers or specialists to ensure timely access to needed care or services.
Conduct telephonic, digital, home, or other site outreach to assess member needs and collaborate with resources.
Collect, document, and maintain member information and care management activities to ensure compliance with state, federal, and third-party payer regulators.
Provide or facilitate education for members and their families or caregivers on disease processes, resolving care gaps, provider instructions, care options, referrals, and healthcare benefits.
Provide leadership with feedback on opportunities to improve and enhance cost-effective care and quality delivery for members.
Perform other duties or responsibilities as assigned to meet business needs.
Comply with all policies and standards.