Description
You could be the one who changes everything for our 28 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.
- Develop, assess and adjust, as necessary, the care plan and promote desired outcome
- 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
- 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
- Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
- 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
- For LTSS - 30% travel to perform home visits to members
- For New Hampshire, Massachusetts, & Michigan Complete Health - home visits required
Licenses/Certifications: Current state’s RN license.
For New Hampshire and Massachusetts: Candidates with RN license in good standing in other states than NH, must obtain a NH RN within 90 days of hire. Active driver’s license in good standing preferred.
For Arizona Complete Health - Complete Care Plan: Obstetrics (OB) assignments requires RN experience in OB (clinical, acute care, community)
Pediatric assignments require RN experience in pediatrics (clinical, acute care, community)
For Michigan Complete Health: Licensed RN; licensed nurse practitioner, licensed physician's assistant. Valid driver's license required.
LTSS Requirements: Valid driver’s license and proof of car insurance.
For North Carolina only: Care Managers, this individual shall be responsible for conducting all functions and activities of the care management program and serve as the lead for each care management teams.
- Must reside in North Carolina
- Must be licensed practitioners
- Must be supervised by an RN, LCSW, or psychologist with trauma-based experience and training.
- Note: Care Manager for medical services is a NC - Licensed Registered Nurse in good standing. Care Manager for BH services in NC - Licensed LCSW in good standing.
Behavioral Health (BH) Managers and Full-Time BH Staff: These individuals shall be responsible for integrating into the clinical and care management teams to ensure Member’s behavioral health needs are fully integrated into the service delivery system.
- Must reside in North Carolina
- Experience working in behavioral health managed care and clinical setting
- Licensed behavioral health professional practicing within their scope
For Sunshine Health (FL) Only: Employees supporting Florida's Children’s Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local travel.
For Shared Services: Clinical licensure for multiple states is required
For Illinois Youth Care contract: Required Education/Experience – Bachelor’s Degree in nursing and RN licensure required. One year of clinical experience required. For Illinois YouthCare plan only: Candidates are required to live within the specified region.
For Oklahoma Complete Health Only: Registered nurse with a license to practice in the State of Oklahoma. Must successfully complete the Behavioral Health Case Manager certification training provided through the Department of Mental Health and Substance Abuse Services within (6) months of date of hire.
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.
