Care Manager (RN)

Centene Corporation

21h•Remote

About The Position

Centene is seeking a Care Manager (RN) to join their team. This role is fully remote and requires applicants to reside in Illinois with an active IL RN license. The position will support behavioral health Medicaid members, and prior RN experience in behavioral health is strongly preferred. The Care Manager will develop, assess, and facilitate complex care management activities for members, focusing on physical needs to achieve high-quality, cost-effective healthcare outcomes. This includes creating personalized care plans, assessing member needs and barriers to care, addressing social determinants of health, and collaborating with providers and community resources to meet unmet needs. The role involves ongoing follow-up, monitoring of member status, and revising care plans as necessary. Additionally, the Care Manager will provide resource support, facilitate care management, and may conduct telephonic, digital, or home outreach. Accurate documentation of all member information and care management activities is required to ensure regulatory compliance. The position also involves educating members and their families on disease processes, care gaps, and healthcare benefits, and providing feedback to leadership on improving care delivery. Other duties as assigned by the people leader are also part of the role.

Requirements

Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing.
2 – 4 years of related experience.
RN - Registered Nurse - State Licensure and/or Compact State Licensure required.
Applicants must reside in the state of IL.
Hold an active IL RN licensure.

Nice To Haves

Behavioral health experience as an RN is strongly preferred.

Responsibilities

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.
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 provide 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 towards care plan / service plan goals; collaborate 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.
Facilitate care management and collaborate 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.
Performs other duties as assigned.
Complies with all policies and standards.