RN Care Manager Transition of Care (centene)
Job posting number: #159184 (Ref:1552099)
Job Description
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our 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.
****NOTE: This is a fully remote role serves Medicare membership telephonically by review their needs following recent discharge, and completing a medication reconciliation. Preference will be given to applicants (1) with active compact RN licensure and (2) clinical and case management experience, (3) and who reside in a central or eastern time zone compact licensure state.****
Position Purpose: Performs care management duties to assess, plan and coordinate aspects of medical and supporting services across the continuum of care for post-discharge members, promoting quality and cost effective care. Completes medication review for pre-admission and post-discharge reconciliation. Works with the care management and coordination teams to identify transition support services.
- Evaluates the needs of the member by completing post discharge assessments for members transitioning from healthcare facilities
- Evaluates medication and performs reconciliation between pre-admit and post-discharge medications
- Develops a care/service plan and collaborates with discharge planners, providers, specialists, and interdisciplinary teams to support member transition and discharge needs
- Assesses member current health status, resource needs, services, and treatment plans and provides appropriate interventions
- Facilitates the transition into active care management based on member needs
- Provides or facilitates education and resource materials to members, authorized caregivers, and providers to promote wellness activities to improve member overall quality of care
- Facilitates services between Primary Care Physician (PCP), specialists, medical providers, and non-medical resources as necessary to meet the medical and socio economic needs of members
- 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 regulations
- 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
Education/Experience: Requires a Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 2 – 4 years of related experience.
License/Certification:
- LISW, LCSW, LMSW, LMFT, LMHC, LPC, or RN required
****Additional Details:
• Department: Transitions of Care Program****
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act