Senior Care Manager (RN)

Centene Corp.; New York, Northern (NY, KY); Hybrid; USD 75,000 - 135,000; Full time

Job summary

Centene Corp in New York, NY seeks an experienced registered nurse to assess, plan and implement complex care management activities to improve quality and reduce costs. You will develop personalized care plans, coordinate with providers, and educate members and families on available services and benefits.

The role requires RN licensure in NY, a Bachelor’s degree in Nursing, and 4–6 years of related experience. Typical hours are Monday–Friday, 8am–5pm EST, with a competitive pay range.

Qualifications

• RN license in NY or a valid compact state license.
• Bachelor's degree in Nursing required.
• 4–6 years of related care management experience.

Responsibilities

• Assess, plan, and implement complex care management activities.
• Develop and continuously assess personalized care/service plans with providers.
• Educate members and families on services and benefit options.
• Coordinate between member/caregivers and care provider team for person-centered care.
• Monitor progress and revise plans to meet goals and needs.
• Identify barriers and propose care management interventions for escalated cases.
• Ensure compliance with state, federal, and payer regulations.
• May precept clinical new hires and support onboarding.

Skills

Care coordination

Patient education

Clinical assessment

Education

Bachelor's degree in Nursing

Job description

**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.**Key Details:** This position requires NY RN State Licensure. Hours are Monday - Friday 8am to 5pm EST.* Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs* 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* 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* May identify problems/barriers for care management and appropriate care management interventions for escalated cases* Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations* Reviews referrals information and intake assessments to develop appropriate care plans/service plans* May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources* Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed* Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators* 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* Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner* 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 * 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* Engages and assists New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success* Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness* Other duties or responsibilities as assigned by people leader to meet business needs* Performs other duties as assigned.* Complies with all policies and standards.**Education/Experience:** Requires a Degree from an Accredited School or 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 requiredPay Range: $75,300.00 - $135,400.00 per year