Complex Discharge Planner

Centene Corporation; Pennsylvania; Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K

Tuition reimbursement

Job summary

Centene seeks an RN to develop, assess, and coordinate complex discharge plans for high-risk members, ensuring safe transitions between care settings. The role supports Marketplace/Ambetter and Medicaid members across multiple states and is remote.

You will educate members and families, interact with providers and utilization review staff, and assist with prior authorizations and concurrent reviews. A compact nursing license and 2+ years acute care experience are preferred.

Qualifications

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing with 2–4 years of related experience.
• 2+ years of acute care experience required.
• Clinical knowledge of discharge planning competencies preferred.
• Knowledge of Medicare and Medicaid regulations preferred.
• Knowledge of utilization management processes preferred.

Responsibilities

• Develops complex discharge plans based on member needs to ensure appropriate level of care.
• Interacts with providers, community agencies, and utilization review staff to coordinate a safe transition plan.
• Assists with managing discharge plans for timely and smooth transitions between care levels.
• Documents discharge plans in health management systems per policies.
• Educates members and families on discharge plan and utilization processes.
• Provides feedback to leadership to improve the discharge planning process.
• Coordinates and assists with completion of prior authorizations related to discharge planning.
• Assists concurrent review team as needed.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Discharge planning

Interdisciplinary coordination

Patient/family education

Education

Nursing degree (RN/BSN)

Tools

Health management systems

Job description

Position Purpose:

Develops, assesses, and coordinates complex discharge plans for high-risk members based upon needs assessment. Assists with the facilitation of a smooth transition from the acute care setting to the next level of care and educates members and their families/caregivers on discharge plan to ensure appropriate high-quality transitional care.

Key Details:

This position is remote/work from home. The hiring leader prefers an RN with a compact nursing license as the role will support our Market Place/Ambetter and Medicaid members in multiple states. We are looking for RNs with LTAC, Inpatient Rehab. or Skilled Nursing Facility experience to support this Utilization Management role. The work schedule is Monday - Friday, 8am - 5pm based on the time zone in which you reside.

• Develops complex discharge plans based on level of care of members needs determined by needs assessment to ensure appropriate level of care
• Interacts with providers, community agencies, and other utilization review staff to coordinate and ensure a safe, effective, and clinically appropriate transition plan for the member
• Assists with managing member’s discharge plans to ensure a timely and smooth discharge between levels of care and facilities
• Collects, documents, and maintains all discharge plans taken on member medical records in health management systems according to utilization management policies and guidelines
• Assists with providing education to members and their families on discharge plan and utilization processes to ensure high quality appropriate care to members, as applicable
• Provides feedback to leadership on opportunities to improve the discharge planning process for members to ensure high-quality transitional care
• Coordinates and assists with completion of prior authorizations as they related to discharge planning, as applicable
• Assists concurrent review team as needed
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:

Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. 2+ years of acute care experience required.
Clinical knowledge of discharge planning competencies preferred.
Knowledge of Medicare and Medicaid regulations preferred.
Knowledge of utilization management processes preferred.

License/Certification:

• LPN - Licensed Practical Nurse - State Licensure required
• RN - Registered Nurse - State Licensure and/or Compact State Licensure

Pay Range: $27.02 - $48.55 per hour

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.

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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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