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.

Position is Remote but candidate must reside in the Central Time Zone

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 knowledge, experience 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

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

Case load will reflect heavier weighting of complex cases than Care Manager II, commensurate with experience

Serve as a subject matter expert for questions or issues for other Utilization Review and Care Managers, Referral Specialists and Program Coordinators

Audit case reviews to ensure compliance with case management policies and procedures and NCQA requirements

Assist with the development of case management workflows, policies, and procedures

Provide oversight to and assist with training of other case management staff

Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 3+ years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.

Licenses/Certifications: Current state’s RN license. URAC Recognized Care Management Certification must be obtained within 6 months of hire.

For Shared Services: Clinical licensure for multiple states is required

Pay Range: $67,400.00 - $121,300.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

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.