Remote Lead Care Manager RN - Complex Care SME

Socket.dev; United States; Hybrid; USD 87,000 - 161,000; Full time

Job summary

Centene is seeking a remote RN with specialty pharmacy experience to oversee care plans and guide the care management team in delivering high-quality, cost-effective healthcare outcomes. The role involves reviewing plans, triaging issues, and collaborating with providers to close care gaps while ensuring compliance with NCQA standards.

Requires a nursing degree and 5–7 years of related experience with active RN licensure; compensation reflects a pay range based on experience and location within

Qualifications

• Requires a Degree from an Accredited School of Nursing or a Bachelor’s degree in Nursing and 5–7 years of related experience.
• RN licensure in state and/or compact state licensure required.
• Specialty pharmacy experience is a plus.

Responsibilities

• Oversees and reviews care plans/service plans and collaborates with providers to identify resources.
• Guides development of care/service plans and triages issues to appropriate providers.
• Ensures quality control and adherence to policies within the care management team.
• Monitors member status/outcomes and revises care plans as needed.
• Provides SME insights to enhance member care within the care plan.

Skills

RN license

Care management

Healthcare experience

Remote work

Education

Bachelor's degree in Nursing

Accredited School of Nursing

Job description

Centene is seeking a remote RN with specialty pharmacy experience to oversee care plans and guide the care management team in delivering high-quality, cost-effective healthcare outcomes. The role involves reviewing plans, triaging issues, and collaborating with providers to close care gaps while ensuring compliance with NCQA standards.

Requires a nursing degree and 5–7 years of related experience with active RN licensure; compensation reflects a pay range based on experience and location within