Care Navigator

Carolina Complete Health; North Carolina; On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene in North Carolina is seeking a Care Manager to assess member needs, coordinate care, and develop personalized care/service plans. You will educate members and families on available services and benefits to improve access to high-quality care.

You will work with care teams to identify providers and community resources, monitor progress toward goals, maintain member records, and ensure compliance with state and payer requirements.

Qualifications

• Requires a Bachelor’s degree and 2–4 years of related experience.
• Graduate from an Accredited School of Nursing if holding clinical licensure or equivalent experience.
• Current state’s clinical license preferred.

Responsibilities

• Evaluates member needs, barriers to care, and available resources to plan optimal outcomes.
• Develops or contributes to personalized care plans and coordinates with providers and community resources.
• Provides psychosocial and resource support to members, caregivers, and care managers to access local services.
• Coordinates between member/family and care teams to ensure timely access to care.
• Monitors progress toward care goals and collaborates with providers for plan revisions.
• Maintains all member information to ensure compliance with state, federal, and payer regulations.

Education

Bachelor’s degree and 2–4 years of related experience

Job description

Position Purpose

Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.

Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.

Key Details

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Qualified candidates must live in North Carolina. Experience with children ages 0–5 and resource coordination is preferred.

• Evaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome
• Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care
• Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans
• Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner
• May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
• May perform on-site visits to assess member’s needs and collaborate with providers or resources, as appropriate
• May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits
• Other duties or responsibilities as assigned by people leader to meet the member and/or business needs
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience

Requires a Bachelor’s degree and 2 – 4 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

License/Certification

Current state’s clinical license preferred

About Centene

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• 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, including full-time or part-time status.
• Total compensation may also include additional forms of incentives.
• Benefits may be subject to program eligibility.

Equal Opportunity Statement

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act