Pediatric Care Manager (RN)

Sunshine State Health Plan; Miami Gardens (FL); Remote; USD 55,000 - 99,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated care manager to transform the lives of its members. This remote position focuses on developing personalized care plans and providing vital support to families in need. With a commitment to high-quality, cost-effective healthcare outcomes, you'll evaluate member needs, collaborate with providers, and ensure timely access to essential services. Join a team that values flexibility and offers competitive benefits, including health insurance and a 401K plan. If you have a passion for pediatric care and a desire to make a difference, this is the perfect opportunity for you.

Benefits

Health Insurance

401K Plan

Tuition Reimbursement

Paid Time Off

Flexible Work Schedule

Qualifications

• 2+ years of pediatric experience required.
• Requires RN - Registered Nurse - State Licensure.

Responsibilities

• Develops and facilitates complex care management activities.
• Coordinates care between members, families, and providers.
• Provides ongoing follow-up and monitoring of member status.

Skills

Pediatric Care

Care Management

Patient Education

Assessment Skills

Collaboration

Education

Degree from an Accredited School of Nursing

Bachelor's degree in Nursing

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Location : Position is 100% remote. Candidate must live in Florida.

2+ years of pediatric experience required.

Position Purpose :

Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.

1. Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and / or facilitates the plan for the best outcome.
2. Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and / or community resources to address member's unmet needs.
3. Identifies problems / barriers to care and provides appropriate care management interventions.
4. Coordinates as appropriate between the member and / or family / caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services.
5. Provides ongoing follow-up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborates with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs.
6. Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate.
7. Facilitates care management and collaborates with appropriate providers or specialists to ensure member has timely access to needed care or services.
8. May perform telephonic, digital, home, and/or other site outreach to assess member needs and collaborate with resources.
9. Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.
10. Provides and/or facilitates education to members and their families / caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits.
11. Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner.
12. Other duties or responsibilities as assigned by people leader to meet business needs.
13. Performs other duties as assigned.
14. Ensures compliance with all policies and standards.

Education / Experience :

Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of related experience.

• 2 years of pediatric experience required.

License / Certification :

• RN - Registered Nurse - State Licensure and / or Compact State Licensure required.

Location : Position is 100% remote. Candidate must live in Florida.

Pay Range : $55,100.00 - $99,000.00 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 skills, experience, education, and other job-related factors permitted by law. Total compensation may include additional incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.