Senior Care Manager (RN)

Centene Management Company•Macomb, MI

18d•Hybrid

About The Position

The Senior Care Manager (RN) assesses, plans, and implements complex care management activities to support quality, cost-effective healthcare outcomes. The role develops personalized care plans or service plans, addresses care needs, and educates members and their families or caregivers about services and benefit options. The position supports members in Wayne and Macomb counties and requires up to 75% local travel. The remaining work may be performed remotely from home. The schedule is Monday through Friday, 8 a.m. to 5 p.m. Required computer equipment is provided, and mileage is reimbursed at the current IRS rate. The role may also support clinical new hires as a preceptor, helping build core skills, coaching and guiding onboarding, facilitating readiness for service coordination, and working with people leaders and cross-functional teams to monitor readiness. Other duties may be assigned to meet business needs. The position must comply with all policies and standards.

Requirements

Degree from an accredited school of nursing or a Bachelor’s degree in Nursing.
4–6 years of related experience.
Registered Nurse (RN) state licensure and/or compact state licensure required.

Responsibilities

Develop and continuously assess care plans or service plans, collaborating with providers to identify specialists and community resources that can address members’ unmet needs.
Coordinate between members or their families and caregivers and the care provider team to ensure members receive adequate, appropriate, person-centered care or services.
Monitor care plans, member status, changes in condition, and progress toward goals; collaborate with members, caregivers, and providers to revise plans as needed.
Identify problems or barriers to care management and appropriate interventions for escalated cases.
Review member data to identify trends and improve operating performance and quality of care in accordance with state and federal regulations.
Review referral information and intake assessments to develop appropriate care plans or service plans.
Conduct telephonic, digital, home, or other site outreach to assess member needs and collaborate with resources.
Collaborate with healthcare providers to facilitate member services or treatments and determine revised care plans when 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 their families or caregivers on disease processes, resolving care gaps, provider instructions, care options, referrals, and healthcare benefits.
Partner with the leadership team to improve care and quality delivery in a cost-effective manner.
May precept clinical new hires by building core skills, coaching, facilitating growth, and guiding onboarding.
Provide guidance and support to clinical new hires or preceptees as they navigate a Managed Care Organization, including coaching and shadowing to bridge classroom training and field practice.
Engage and assist new hires or preceptees during onboarding, including completing competency checkpoints and ensuring readiness for service coordination.
Work collaboratively with people leaders and cross-functional teams to measure and monitor readiness.
Perform other duties as assigned and comply with all policies and standards.