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Care Manager I Remote Opportunity

Federal Services Tempe, Arizona, Denver, Colorado, Las Vegas, Nevada, Albuquerque, New Mexico, Everett, Washington

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 1169151
Additional Locations Denver,Colorado,US;Las Vegas,Nevada,US;Albuquerque,New Mexico,US;Everett,Washington,US
Category Clinical & Nursing
Schedule Full-time
Description:

Position Purpose: Provides case/care management services to a specific clientele. Screens cases for possible case management services according to predetermined criteria. Systematically identifies and addresses fragmentation of care, and fill gaps in care using proactive initiatives. Authorizes inpatient and/or outpatient treatment according to company's stated criteria. Evaluates physician's treatment plan and other records to develop a care plan to assist patient to move as rapidly and cost effectively as possible through health care services. Consults with providers, beneficiaries and family members as needed. Documents all initial and concurrent reviews including, but not limited to, diagnosis, symptoms, interventions, goals and plans for next review. Identifies providers for specialized services and negotiates rates when services are provided outside the contracted provider network.

  • Coordination of Care
  • Contacts members of the medical team to discuss the patient’s course of progress and needs.
  • Arranges for all services required and coordinates services with the health care team to eliminate duplication of services and conserve health benefit dollars.
  • Contacts or visits family to ascertain their understanding of the patient’s diagnosis and prognosis and the ability to provide caregiver support.
  • Checks homes for safety factors or architectural barriers and arranges for any modifications.
  • Reevaluates equipment, supplies and services.
  • Identifies problems, anticipates complications and acts to avoid them, provides health instruction to the patient and family and refers the patient back to the physician or other health care team members when appropriate.
  • Identifies plateaus, improvements, regressions and depressions; counsels accordingly and recommends help.
  • Makes personal visits or contacts the physician to clarify diagnosis, prognosis, therapies, activities of daily living, etc.
  • Provides authorizations for any modalities of treatment recommended; investigates and suggests alternative treatments when appropriate.
  • Assists with obtaining information and forms which regard living wills, health care proxies, do-not-resuscitate orders, etc.
  • Shares pertinent patient information with the physician to achieve the best outcome.
  • Documents case summary based on information received and communicates with the beneficiaries and involved providers.
  • Conducts personal visits to the patient’s home or to the hospital when appropriate.
  • Facilitates transfers of beneficiaries throughout the different regions, and within the region, by collaborating with the military liaison to transition the beneficiary with minimal disruption of their health care services.
  • Coordinates the basic benefits and identifies and submits benefit modifications as appropriate or submits a request to TMA for benefit exceptions or special programs.
  • Coordination of Financial Services
  • Assesses the patient’s benefit plan for coverage and limitations.
  • Negotiates cost-effective rates for provider services, which includes: Contacting multiple providers to allow a rate comparison of specialty items and identifying the most cost-effective approach; Researching and identifying appropriate equipment that will meet the beneficiaries’ needs and pursuing contracts with these providers; Suggesting medically appropriate alternatives to accomplish treatment plan goals more cost effectively.
  • Counsels the patient or family on budgeting and notifying creditors.
  • Identifies financial distress and refers the patient or family to appropriate community resources.
  • Helps the patient or family sort and prioritize unpaid bills.
  • Acts as a liaison among secondary insurance payers.
  • Case Managers Only:
  • Evaluates Referrals for Case Management Services.
  • Contacts patient to assess the patient’s condition, understand his/her injury and their ability to follow the treatment plan.
  • Aids with behavioral/motivational activities.
  • Explores the patient’s feelings about his/her injury or illness and helps the patient with associated trauma and frustration.
  • Monitors the family’s feelings regarding the patient’s illness and observes the family’s ability or inability to mange new emotional stress.
  • Offers information about the patient’s condition.
  • Enlists qualified counselor to assist with problems arising from the injury or illness.
  • Customer Education
  • Educates physicians and appropriate MTF personnel regarding benefits and limitations, as well as payment processes.
  • Educates internal staff regarding program benefits and changes.
  • Collaborates with physicians, beneficiaries/families, and involved providers to evaluate beneficiary needs and ensure beneficiaries are receiving adequate services to meet their needs.
  • Educates beneficiaries to help them understand their benefits and assists them with maximizing their available benefits.
  • Training
  • Conducts training for other HNFS associates regarding the overall Case Management Program and specific processes such as the case management referral process.
  • Care Managers Only:
  • Pre-admission Counseling
  • Contacts patients with upcoming medical or surgical admissions and discusses what they may expect before, during and after the admission.
  • Assesses patients’ conditions, understanding of their illnesses/ injuries and their abilities to follow the treatment plans.
  • Advises patients of the probable length of stay and helps them think through and arrange for services that they might need when discharged from the hospital.
  • Admission Care
  • Works directly with physicians and hospitals to enforce the physicians’ treatment plans and orders.
  • Ensures patients receive specialty care and tests when ordered.
  • Post Discharge Follow-up
  • Contacts patients within 48 hours of discharge and assures proper support and services are in place to make a full recovery (i.e., equipment, home health, other services, transportation, etc.).
  • Assesses appropriate and timely receipt of equipment, home health and other services.
  • Assesses compliance with medications and follow-up appointments.
  • Assists patients with coordination of transportation and other needs as necessary.
  • Ensures patients effectively navigate the health care system.

  • Qualifications:

    Education/Experience: Graduate of Nursing program; BSN degree preferred. Two (2) years clinical experience in a health care environment
    Managed care experience desirable

    Behavioral Health Background a Must! Utilization Management a Plus!

    License/Certification:Nurse License, Clinical Psychologist, or Licensed Clinical Social Worker. Must maintain current, valid and unrestricted clinical license. Valid State Drivers License and Certified in Case Management (CCM) recommended


    This position will be supporting a Federal government contract, therefore it requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security.

    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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