Care Manager (RN)

Centene Corporation•Remote-IL, IL

1d•$56,200 - $101,000•Remote

About The Position

Develops, assesses, and facilitates complex care management activities for members with primarily physical needs to support high-quality, cost-effective healthcare outcomes. The role includes creating personalized care plans and educating members and their families. This position supports Illinois Medicaid High Risk Maternity members and is remote/work from home. An active, current, unrestricted Illinois RN license is required. The work schedule is Monday through Friday, 8 a.m. to 5 p.m. Central Time. The hiring leader prefers candidates with both care or case management and high-risk maternity experience. The Care Manager evaluates member needs and barriers to appropriate care, including social determinants of health, and develops or facilitates plans that focus on member-identified priorities. The role coordinates with members, families, caregivers, providers, specialists, and community resources; monitors progress toward care plan goals; and provides education and resource support. Outreach may be conducted by telephone, digitally, at home, or at other sites. The position also documents care management activities to meet applicable regulatory requirements, provides feedback to leadership about opportunities to improve care and quality cost-effectively, and performs other assigned duties while complying with applicable policies and standards.

Requirements

Degree from an accredited school of nursing or a bachelor’s degree in nursing.
2–4 years of related experience.
Registered Nurse (RN) state licensure and/or compact state licensure required.
Active, current, unrestricted Illinois RN licensure required for this role.

Nice To Haves

Experience in both care or case management and high-risk maternity.

Responsibilities

Evaluate member needs and barriers to accessing appropriate care, including social determinants of health, and recommend or facilitate plans focused on the member’s priorities.
Develop ongoing care plans or service plans and collaborate with providers to identify providers, specialists, and community resources for 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 support 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 needed.
Provide resource support to members and care managers for local services such as employment, housing, participant direction, independent living, justice, and foster care, as appropriate to assessments and plans.
Facilitate care management and collaborate with providers or specialists to help members access needed care or services in a timely manner.
Conduct telephonic, digital, home, or other site outreach to assess member needs and collaborate with resources, as needed.
Collect, document, and maintain member information and care management activities to ensure compliance with applicable state, federal, and third-party payer requirements.
Provide or facilitate education for members and families or caregivers about disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits.
Provide leadership feedback on opportunities to improve care and quality delivery for members cost-effectively.
Perform other duties or responsibilities as assigned to meet business needs and comply with policies and standards.