Senior Care Manager (RN)

Fidelis Care - New York; New York (NY); Hybrid; USD 73,000 - 133,000; Full time

Job summary

A leading healthcare organization seeks a Senior Care Manager (RN) to assess and implement care management activities for members. This role involves developing personalized care plans, collaborating with healthcare providers, and ensuring compliance with regulations. The ideal candidate will have a nursing degree and experience in care management. Competitive benefits and flexible work options are offered.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• 4 – 6 years of related experience required.
• Requires RN State Licensure.

Responsibilities

• Develops and assesses ongoing care plans and collaborates with providers.
• Coordinates care between members and healthcare teams.
• Monitors member status and revises care plans as necessary.

Skills

Care Management

Patient Education

Collaboration

Education

Degree from an Accredited School of Nursing

Bachelor's degree in Nursing

Job description

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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.

Position Purpose

Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care.

Responsibilities

1. Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources needed to address member's unmet needs
2. Coordinates and manages 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
3. Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs
4. May identify problems/barriers for care management and appropriate care management interventions for escalated cases
5. Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
6. Reviews referrals information and intake assessments to develop appropriate care plans/service plans
7. May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
8. Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed
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. Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner
12. May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness
13. Provides guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice
14. Engages and assists New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
15. Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
16. Other duties or responsibilities as assigned by people leader to meet business needs
17. Performs other duties as assigned
18. 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 4 – 6 years of related experience.

License/Certification

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

Additional Details

Pay Range: $73,800.00 - $132,700.00 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 factors. Total compensation may include additional incentives.

Centene is an equal opportunity employer that values diversity and inclusion. 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.