Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Field Base - Care Manager II (Rn)

Expired Job

Centene Corporation Dayton , OH 45401

Posted 4 months ago

Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.

Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options

Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes

Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients

Provide patient and provider education

Facilitate member access to community based services

Monitor referrals made to community based organizations, medical care and other services to support the members' overall care management plan

Actively participate in integrated team care management rounds

Identify related risk management quality concerns and report these scenarios to the appropriate resources.

Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience

Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems

Direct care to participating network providers

Perform duties independently, demonstrating advanced understanding of complex care management principles.

Participate in case management committees and work on special projects related to case management as needed

Home visits required

For Buckeye Community Health Plan:

Education/Experience: Graduate from an Accredited School of Nursing.

Bachelor's degree in Nursing preferred. 2 years of clinical nursing experience in a clinical, acute care, or community setting and 1 years of case management or utilization experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.

Behavioral Health and/or waivers experience highly preferred.

Licenses/Certifications: Current state's RN license.

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.



upload resume icon
See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
RN Care Manager

Caresource

Posted 6 days ago

VIEW JOBS 1/12/2019 12:00:00 AM 2019-04-12T00:00 Role and Responsibility: * Collaborate with members of an inter-disciplinary team to meet the needs of the individual and the population * Identify problems or opportunities that would benefit from care coordination * Engage the member and complete a health and psychosocial assessment, taking into account the cultural and linguistic needs of each member * Identify and prioritize the individual's care management needs and goals in collaboration with the member and caregivers * Identify and manage barriers to achievement of care plan goals * Identify and implement effective interventions based on clinical standards and best practices * Develop and implement individual care plans and participate in the development of problem focused care plan templates. * Maximize the client's health, wellness, safety, adaptation, and self-care through effective care coordination and case management * Facilitate coordination, communication and collaboration with the client and other stakeholders in order to achieve goals and maximize positive client outcomes * Educate the member and other stakeholders about treatment options, community resources, insurance benefits, etc. so that timely and informed decisions can be made * Employ ongoing assessment and documentation to evaluate the member's response to the plan of care * Evaluate client satisfaction through open communication and monitoring of concerns or issues * Collaborate with facility based case managers and providers to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner * Appropriately terminate care coordination services based upon established case closure guidelines * Provide clinical oversight and direction to unlicensed team members as appropriate * Document care coordination activities and member response in a timely manner according to standards of practice and CareSource policies regarding professional documentation * Starts each intervention with members wondering, "What does the world look like for this person, and how can I meet him or her where they are? What are his or her unique needs, and how can CareSource help?" In each interaction, the employee will aspire to help the member to feel informed, empowered, and supported by CareSource * Looks for ways to improve the process to make the members experience with CareSource easier and shares with leadership to make it a standard, repeatable process * Perform any other job related instructions as requested Requirements Education / Experience: * RN License required * Bachelor's of Science in Nursing (BSN) preferred * Three to five (3-5) years of experience in nursing, social work, or healthcare field (discharge planning, case management, care coordination, and/or home/community health experience) is required * Five (5) years or more clinical experience is preferred * Three (3) years or more Medicaid and/or Medicare managed care experience is preferred Required Competencies / Knowledge / Skills: * Intermediate proficiency level with Microsoft Office, including Outlook, Word and Excel * Ability to operate smart phone, iPad, or other mobile communication devices to ensure productivity and ability to perform essential functions * Ability to communicate effectively with a diverse group of individuals * Ability to multi-task and work independently within a team environment * Collaborate with team members to optimize outcomes for members * Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices * Adhere to code of ethics that aligns with professional practice * Strong advocate for members at all levels of care * Strong understanding and respect of all cultures and demographic diversity * Ability to interpret and implement current research findings * Awareness of community & state support resources * Critical listening and thinking skills * Decision making and problem solving skills * Strong organizational and time management skills * Proven track record of demonstrating empathy and compassion for individuals * Proven track record for improving processes to make things easier for those you have served Licensure / Certification: * Current unrestricted RN license in the State of Service required * Case Management Certification is highly preferred Working Conditions: * Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer * Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our member and may refer members to other CareSource resources Apply On-lineSend This Job to a Friend Copyright © Ultimate Software Caresource Dayton OH

Field Base - Care Manager II (Rn)

Expired Job

Centene Corporation