Senior Care Manager RN - STAR/CHIP

Superior HealthPlan; McAllen (TX); On-site; USD 75,000 - 135,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible remote/office/hybrid work

Remote, hybrid, field or office work S

Job summary

Centene is seeking an experienced Senior Care Manager RN to assess, plan, and implement complex care management activities that improve health outcomes while containing costs. You will develop personalized care/service plans and educate members and families on available benefits and services.

The role involves coordinating between members, families, and care teams, monitoring progress, and revising plans to meet goals. Strong documentation and collaboration with providers are essential.

Qualifications

• Requires a Bachelor’s degree in Nursing and RN licensure.
• 7+ years of clinical nursing RN experience with direct patient care and care coordination.
• Experience with state programs (Medicaid, STAR CHIP) a plus.
• Strong documentation, communication, and organization skills.

Responsibilities

• Assesses, plans, and implements complex care management activities to enable quality, cost-effective care outcomes.
• Develops personalized care/service plans and educates members and families on services and benefits.
• Coordinates between members, families, and care teams to deliver person-centered care.
• Monitors progress and revises care plans to meet goals and unmet needs.
• Collaborates with providers and community resources to address barriers and escalate when needed.
• Maintains comprehensive member information to ensure regulatory compliance.

Skills

RN experience

Clinical nursing

Care coordination

Documentation

Communication

Education

Bachelor's degree in Nursing

RN licensure

Tools

EHR experience

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 Senior Care Manager RN role supports members with physical health conditions, preventive care needs, and chronic disease management, such as asthma, diabetes, hypertension, high cholesterol, respiratory illnesses, or stress-related conditions. Knowledge and experience working with state-government sponsored programs (Medicaid, STAR CHIP) a PLUS. The standard schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m.(CST)

• 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.

Preferred Experience

• 7+ years of clinical nursing RN experience with direct patient care, clinical assessment, person-centered care planning, member outreach, care transitions, access to care, family & patient education, and ongoing service coordination for members (ages: 0- 65), but primarily with the adult population.
• Strong clinical documentation, problem-solving, communication, attention to detail, organization/time management skills, and works well under quick TAT times and deadlines are required.
• Ability to adapt to changing business needs with openness, flexibility, and professionalism.

License/Certification

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

Pay Range: $75,300.00 - $135,400.00 per year

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, and 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