Care Manager II (RN)- Field-based
Posted on: September 17, 2020
- Perform care management duties to assess, plan and coordinate
all aspects of medical and supporting services across the continuum
of care for select members to promote quality, cost effective
- Assess the member's current health status, resource
utilization, past and present treatment plan and services,
prognosis, short and long term goals, treatment and provider
- Utilize assessment skills and discretionary judgment to develop
plan of care based upon assessment with specific objectives, goals
and interventions designed to meet member's needs and promote
- Coordinate services between Primary Care Physician (PCP),
specialists, medical providers, and non-medical staff as necessary
to meet the complete medical socio economic needs of clients
- Provide patient and provider education
- Facilitate member access to community based services
- Monitor referrals made to community based organizations,
medical care and other services to support the members overall care
- Actively participate in integrated team care management
- Identify related risk management quality concerns and report
these scenarios to the appropriate resources.
- Case load will reflect heavier weighting of complex cases than
Care Manager I, commensurate with experience
- Enter and maintain assessments, authorizations, and pertinent
clinical information into various medical management systems
- Direct care to participating network providers
- Perform duties independently, demonstrating advanced
understanding of complex care management principles.
- Participate in case management committees and work on special
projects related to case management as needed
- For New Hampshire, Massachusetts, & Michigan Complete Health -
home visits required
Education/Experience: Graduate from an Accredited School of
Nursing. Bachelors degree in Nursing preferred. 2+ years of
clinical nursing or case management experience in a clinical, acute
care, managed care or community setting. 2+ years experience
working with people with disabilities and vulnerable populations
who have chronic or complex conditions in a managed care
environment. Experience with medical decision support tools (i.e.
Interqual, NCCN) and government sponsored managed care programs.
Other state specific requirements may apply.
Licenses/Certifications: Current states RN license.
- 75% travel post-Covid-19 within Hidalgo and possibly Willacy
County-Harlingen/Raymondville and Weslasco/Donna area
Bilingual in Spanish
Centene is an equal opportunity employer that is committed to
diversity, and values the ways in which we are different. All
qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, sexual orientation,
gender identity, national origin, disability, veteran status, or
other characteristic protected by applicable law.
Keywords: Centene, Dallas , Care Manager II (RN)- Field-based, Healthcare , Tioga, Texas
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