Senior Care Manager (RN)
Company: Superior HealthPlan
Location: Afton
Posted on: May 28, 2023
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Job Description:
You could be the one who changes everything for our 26 million
members as a clinical professional on our Medical Management/Health
Services team. Centene is a diversified, national organization
offering competitive benefits including a fresh perspective on
workplace flexibility.
Prefer candidate to live near/around El Paso, TX.
Candidate must reside in TX.
Position Purpose: 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 care
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 options.
Utilize knowledge, experience 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
desired outcomes
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
management plan
Actively participate in integrated team care management rounds
Identify related risk management quality concerns and report these
scenarios to the appropriate resources
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
Case load will reflect heavier weighting of complex cases than Care
Manager II, commensurate with experience
Serve as a subject matter expert for questions or issues for other
Utilization Review and Care Managers, Referral Specialists and
Program Coordinators
Audit case reviews to ensure compliance with case management
policies and procedures and NCQA requirements
Assist with the development of case management workflows, policies,
and procedures
Provide oversight to and assist with training of other case
management staff
Education/Experience: Graduate from an Accredited School of
Nursing. Bachelor's degree in Nursing preferred. 2+ years of
clinical nursing or case management experience in a clinical, acute
care, managed care or community setting. 3+ 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. Pediatric experience
required.
Prefer candidate to live near/around El Paso, TX.
Candidate must reside in TX.
Licenses/Certifications: Current state's RN license.
Our Comprehensive Benefits Package: Flexible work solutions
including remote options, hybrid work schedules and dress
flexibility, Competitive pay, Paid time off including holidays,
Health insurance coverage for you and your dependents, 401(k) and
stock purchase plans, Tuition reimbursement and best-in-class
training and development.
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: Superior HealthPlan, Lubbock , Senior Care Manager (RN), Executive , Afton, Texas
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