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Centene

Runs government-backed health insurance plans

Care Manager - RN

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timeMississippi, USA

About the Job

Requirements

  • A degree from an accredited school of nursing or a bachelor's degree in nursing is required.
  • Two to four years of related experience are required.
  • An RN state license or compact state license is required.
  • The candidate must be licensed in Mississippi.
  • The candidate must live in Mississippi.

Responsibilities

  • Evaluate member needs, barriers to appropriate care, and social determinants of health, prioritizing concerns identified by the member and recommending or facilitating plans for optimal outcomes.
  • Develop ongoing care plans or service plans and collaborate with providers to identify providers, specialists, and community resources that address members' unmet needs.
  • Identify problems and barriers to care and provide appropriate care management interventions.
  • Coordinate between members or their families and caregivers and the care provider team to ensure members receive adequate, appropriate, person-centered care or services.
  • Follow up and monitor member status, changes in condition, and progress toward care plan or service plan goals; collaborate with members, caregivers, and providers to revise or update plans as needed to meet goals and unmet needs.
  • Provide resource support to members and care managers for local services such as employment, housing, participant direction, independent living, justice, and foster care, based on service assessments and plans as appropriate.
  • Facilitate care management and collaborate with providers or specialists to ensure members have timely access to needed care or services.
  • Conduct telephonic, digital, home, or other site outreach to assess member needs and collaborate with resources.
  • Collect, document, and maintain member information and care management activities to ensure compliance with current state, federal, and third-party payer regulations.
  • Provide or facilitate education for members and their families or caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits.
  • Provide feedback to leadership on opportunities to improve care and quality delivery for members in a cost-effective manner.
  • Perform other duties or responsibilities as assigned to meet business needs.
  • Comply with all policies and standards.

About the Company

Centene

Runs government-backed health insurance plans

Centene runs government-backed health insurance plans in the United States, with Medicaid as its largest business alongside Medicare and Affordable Care Act Marketplace coverage. It is one of the largest Medicaid insurers in the country and also runs plans for people eligible for both Medicare and Medicaid, long-term care and children in foster care. States and the federal government pay Centene a set amount per member to manage care, and individuals buy its Ambetter Marketplace plans, often with federal subsidies. Centene contracts with local doctors, hospitals and pharmacies and keeps the difference between premiums and the cost of care. The company was founded in 1984 in Milwaukee and is headquartered in Clayton, Missouri.

Company size
10,001+
Company stage
IPO
Headquarters
Clayton, MO
Founded
1984

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