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Care Manager, Health and Recovery Plan

Fidelis Care New York, New York

As a member of the Centene Medical Management/Health Services team, you’ll help innovate and execute strategies that redefine the industry standard for improving the lives and health of people. We’re a team of skilled physicians, nurses, pharmacists, social workers and health service experts who use our advanced clinical analytics to implement award winning programs, develop care, deliver partnerships, and work directly with our members to achieve outcomes that set us apart as industry leaders. Together, we’re transforming the health of communities, one person at a time.

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What does it take?

What are the qualities that will help you achieve success in this role at Centene?

Success Profile

  • Detail-oriented
  • Trustworthy
  • Personable
  • Quick-thinking
  • Multi-tasker
  • Good listener

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Our Medical Roles

Clinical & Nursing Opportunities at Centene

Our Clinical team is at the forefront of our purpose-driven work. Learn more about how you can help transform the health of our communities, one person at a time.

Overall Medical Management

A member of the Centene Medical Management team, we innovate and execute strategies that redefine the industry standard for improving the lives and health of people.

Concurrent Review Nurse

To ensure our members get the best quality of care, you’ll assess acute member health conditions, treatment and intervention options, and match them with providers, community and health plan resources.

Prior Authorization Nurse

You’ll ensure our members get the best quality services, assistive devices, and equipment to promote optimal health and independence in the community and help promote health and independence.

Care Manager

Working directly with members, interdisciplinary care team, providers and data analytics, you’ll identify member health risks and conditions and intervention and service options.

LTSS Program Specialist/Program Specialist Field Based

Working directly with our most vulnerable members, you’ll identify individual member health risks and opportunities to enhance independence, quality of life and community engagement.

Referral Specialist

You’ll use our data systems to directly assist providers, requesting services and treatments for our members.

Medical Director

To help support the individual needs of members and develop programs that address issues, you’ll review population health data, help design clinical programs, and develop care delivery partnerships.

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Responsibilities

Job ID 1151084

Category Clinical & Nursing
Schedule Full-time
Description:
Position Purpose: Perform work associated with promoting and restoring the health of Health and Recovery Plan (HARP) members by identifying member care requirements, documenting, and ensuring maximal access to high quality care across the continuum. Collaborate with Member, Health Homes, physicians, other interdisciplinary team members, and family members and/or supportive others to support and sustain the Member’s wellness and recovery goals. Follows best practice and clinical standards, and adheres to departmental and State guidelines.

Mental Health/Chemical Dependency: Utilize expertise of best practice standards to render medical and social necessity determinations.
Quality of Care: Adhere to clinical standards of care through collaboration with providers in order to ensure appropriate outcomes.
Case Management: Communicate with members, family and other medical personnel as necessary to facilitate a desired outcome.
Pharmacology: In collaboration with Physician Advisor, assess appropriateness and effectiveness of medications in order to determine a medications use, dosage, side effect as applied to different disease states.
Electronic Records: Manage electronic files to create patient files in order to document patient records, treatments, and progress.
Regulatory Guidelines: Practice and adhere to departmental and state guidelines in order to protect self, members, and organization.
Professional Development: Attend educational workshops; review professional publications; establish personal networks; participate in professional societies in order to maintain professional and technical knowledge.
Other duties as required: Performs other tasks in order to contribute to the team effort.
Qualifications:

Education/Experience: MA/MS Masters Degree or equivalent required. One to three years clinical and managed health care experience required. Three to five years experience working with Behavioral Health and/or Substance Use required.

3 years' post-Master's experience strongly preferred

License/Certification: NYS LMFT, LMSW, LCSW, LMHC, or RN, License required

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.
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Quote

“Centene is an exciting company to work for, the pace at which we’re growing allows numerous advancement opportunities. Also, we foster an environment that supports and offers numerous leadership growth opportunities.”

- Esmeralda Baig, SVP Operations, Complex Care Products

“I assisted with one of the Provider fairs in the community. Seeing how much we care for our community and our patients was very eye opening.”

- Julie Boulch, Director, Business Implementation Health Plan Initiatives

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Our Awards

Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.

Honored to be Honored

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Our Hiring Process

Learn more about our hiring process and discover other helpful information for applicants.

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“Flexibility is key. Centene is a company of change.”

Ashley Collier

Started as a Referral Specialist, now a Project Manager IV

See Ashley's career path

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