Complex Discharge Planner

Centene Management Company LLC; Pennsylvania; Hybrid; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Job summary

Centene Management Company LLC is seeking an RN with a strong discharge planning background to support marketplace, Ambetter and Medicaid members in multiple states. The role is remote with a standard M-F schedule and requires licensure in good standing.

You will coordinate complex discharge plans, educate families, and collaborate with providers to ensure safe, timely transitions between care settings. Qualifications include RN/LPN licensure, a nursing degree, and 2+ years acute care

Qualifications

• Requires 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.
• Knowledge of Medicare/Medicaid regulations preferred or utilization management processes.

Responsibilities

• Develops complex discharge plans for high-risk members.
• Coordinate transitions between levels of care.
• Educate members and families on discharge plan and processes.
• Assist with prior authorizations related to discharge planning.

Skills

Discharge planning

Acute care experience

Utilization management

Care coordination

Education

Bachelor's degree in Nursing

Accredited nursing program

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
• 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

Thanks for your interest in Centene and its subsidiary companies. We’re so glad that you’ve decided to fill out an application and take the next step to find your purpose. Also, we’re here to help support you on your candidate journey. Should you need an accommodation, please email [e-mail]. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.