Senior Care Manager (RN)

Centene Corporation

21h•Hybrid

About The Position

Centene is transforming the health of communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. This position supports our Fidelis LTSS Member Population. The role assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. It involves developing personalized care plans, addressing issues, and educating members and their families/caregivers on available services and benefit options. The role also involves continuous assessment of care plans, collaboration with providers to identify necessary resources, and monitoring member status to revise plans as needed. Additionally, it may involve telephonic, digital, home, or other site outreach, collaboration with healthcare providers, and maintaining member information in compliance with regulations. Education and facilitation of disease process, care options, and benefit education for members and families are key. The role also partners with the leadership team to improve care delivery and may involve precepting clinical new hires, guiding them through onboarding, and ensuring readiness for service coordination success. This includes engaging in a collaborative process with People Leaders and cross-functional teams to measure and monitor readiness. Other duties as assigned by the people leader to meet business needs.

Requirements

Degree from an Accredited School or Nursing or a Bachelor's degree in Nursing
4 – 6 years of related experience
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
NY RN Licensure in order to be eligible for this position that supports our Fidelis LTSS Member Population

Responsibilities

Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes.
Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care.
Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs.
Coordinates and manages 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.
Monitors care plans / service plans and/or 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.
May identify problems/barriers for care management and appropriate care management interventions for escalated cases.
Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations.
Reviews referrals information and intake assessments to develop appropriate care plans/service plans.
May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources.
Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed.
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.
Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner.
May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness.
Provides guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice.
Engages and assists New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success.
Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness.
Other duties or responsibilities as assigned by people leader to meet business needs.
Performs other duties as assigned.
Complies with all policies and standards.