Pediatric RN Case Manager

Centene Corporation Fort Lauderdale , FL 33301

Posted 2 months ago

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

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

  • Develop, assess and adjust, as necessary, the care plan and promote desired outcome

  • 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

  • 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

  • Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs

  • 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

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

Additional Details:

  • Department: Children's Medical Services

  • Caseload: Pediatrics - Newborn to 21-year old. Caseload based on residence.

  • Territory: Territory: Broward County (Lauderhill. Fort Lauderdale). Work-from-home case management role with local in-home visits. Must reside in or be willing to relocate to the above mentioned area of Florida.

Our Comprehensive Benefits Package:

  • Flexible work solutions including remote options, hybrid work schedules and dress flexibility

  • Competitive pay

  • Paid Time Off including paid holidays

  • Health insurance coverage for you and dependents

  • 401(k) and stock purchase plans

  • Tuition reimbursement and best-in-class training and development

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. Knowledge of healthcare and managed care preferred.

Licenses/Certifications: Current state's RN license.

For Sunshine Health (FL) Only: Employees supporting Florida's Children's Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local travel.

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.

icon no score

See how you match
to the job

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 Triage Telephonic Nurse CaseManager FL Workers Compensation

Brown & Brown, Inc.

Posted 1 week ago

VIEW JOBS 6/17/2022 12:00:00 AM 2022-09-15T00:00 Built on meritocracy, our unique company culture rewards self-starters and those who are committed to doing what is best for our customers. We'd love to welcome you to our team! Just like the distinct spots on a cheetah, the mascot of our parent company, Brown & Brown, every teammate at USIS/AmeriSys is unique and we are passionate about embracing our diversity. Our team is connected through shared core values of integrity, grit and The Power of WE, which are part of our cultural DNA. At USIS/AmeriSys, we provide Third Party Claims Administration and Medical Management services for Workers' Compensation and Liability claims on behalf of our customers. We work hard for our customers, and we make friends at work! As a recertified 2021 - 2022 Great Place to Work®, we pride ourselves on our friendly, team-orientated work environment. Our energetic team and can-do attitude enhance a sense of collaboration and belonging in our teammates, with supportive leaders who are mentors striving to offer opportunities for growth. We encourage a healthy work-life balance for all teammates and provide five weeks Paid Time Off, Floating Holiday, Culture Day as well as ten regular company-paid holidays. Our great benefits include medical, dental, vision, short- and long-term disability, life insurance options, Aflac critical illness and accident insurance, as well as financial wealth-building options like our Employee Stock Purchase Plan (15% discount), and 401(k) with company match. AND WORK FROM HOME! As a Triage Telephonic Nurse Case Manager on our team, you would be responsible for performing telephonic initial triage assessment of injured workers under Florida Workers' Compensation law. Our team will rely on you to ensure high quality of care and reduce recovery time to promote an appropriate, prompt return to work. In this role, you will be responsible for clinically evaluating the recovery needs of an injured employee after the initial contact assessment, incorporating information obtained from the employer and medical provider into the initial plan ensuring that, as soon as medically feasible, return-to-work status is achieved. Opportunity to work from home. What You'll Be Doing: * Provide triage case-management in a Workers' Compensation environment at the initial report of the claim. Focus on medical appropriateness of care to the injured worker with cost savings by coordination and utilization of all services, ensuring that as soon as medically feasible, return-to-work status is achieved. * Utilize keen clinical assessment skills to ascertain all pertinent information from the injured employee to facilitate appropriate care. * Clinically evaluate the recovery needs of an injured employee after the initial contact assessment. Incorporate information obtained from the employer and provider into the initial plan. * Facilitate communication between the employee, the employee representative, employer, employer representative, insurer, health care provider, and the medical services organization and when authorized, any qualified rehabilitation consultant. * Anticipate health needs during case-management process and educate patient and family appropriately. Encourage the injured worker to participate in the recovery plan. * Serve as a patient advocate adhering to all legal, ethical and accreditation/regulatory standards. * Participate as backup to assist with intake calls as necessary, ensuring expedient care to the injured employees and being knowledgeable of all functions of the department. * Perform other duties as needed. Required Skills: * Registered Nurse RN with a minimum of three years clinical experience (orthopedic, neurological, neuromuscular, ICCU, industrial or occupational). * Excellent clinical assessment skills required. * Florida Workers' Compensation case management or occupational experience helpful. * Bi-lingual helpful (English/Spanish). * Must be able to work a computerized diary system, keep the diaries current and document accordingly. * Must work productively and independently to accomplish goals of the job per caseload according to contractual performance standards. * Excellent verbal and written communication skills. Good customer service skills and strong organizational skills. * Must be technically adept to utilize systems software in efficient and effective manner with dual monitors and multiple data entries. * Ability to work effectively in fast-paced environment, using own initiative, effectively multi-task and prioritize. Our focus is on quality, professional, superior service. This service-driven philosophy, conveyed throughout the organization, means we operate with the customers' best interests at heart, constantly reinforcing our mission - Service Beyond the Contract. Salary Range Competitive, based on experience. We are an Equal Opportunity Employer. We take pride in the diversity of our team and seek diversity in our applicants. Brown & Brown, Inc. fort lauderdale FL

Pediatric RN Case Manager

Centene Corporation