Care Navigator

Centene Corporation

1d•$23 - $39•Remote

About The Position

Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination. Evaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators May perform on-site visits to assess member’s needs and collaborate with providers or resources, as appropriate May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits Other duties or responsibilities as assigned by people leader to meet the member and/or business needs Performs other duties as assigned. Complies with all policies and standards.

Requirements

Must reside in Illinois
Requires a Bachelor’s degree and 2 – 4 years of related experience.
Graduate from an Accredited School of Nursing if holding clinical licensure Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

Nice To Haves

Current state’s clinical license preferred

Responsibilities

Conduct outbound calls to members to complete Health Risk Assessments
Create care plans based on member needs
Provide members with appropriate resources and support
Manage a monthly caseload while meeting required outreach timeframes
Complete work accurately and efficiently while maintaining quality standards
Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.
Evaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome
Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care
Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans
Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner
May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
May perform on-site visits to assess member’s needs and collaborate with providers or resources, as appropriate
May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits
Other duties or responsibilities as assigned by people leader to meet the member and/or business needs
Performs other duties as assigned.
Complies with all policies and standards.