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Care Manager II (FIELD RN)

Superior HealthPlan San Antonio, Texas

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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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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Responsibilities

Job ID 1153141

Category Clinical & Nursing
Schedule Full-time
Description:

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 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 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.
  • 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
  •  Approximately 80%-90% local travel to visit members in assigned area
  • Qualifications:

    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. 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 state’s RN license and valid driver's license are 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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    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

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    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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    Our Awards

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

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    Our Hiring Process

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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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