About this role
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.
This is a remote position. Hours are M-F 8:00 am-5:00 pm Pacific Standard Time (PST). WA State RN Licensure and/or Compact State Licensure required.
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/caregivers on services and benefit options available to receive appropriate high-quality care.
- 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-effecti