Pediatric RN Care Manager - Remote Available
Company: Sunshine State Health Plan
Posted on: November 19, 2021
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
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
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
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
For LTSS - 30% travel to perform home visits to members
For New Hampshire, Massachusetts, & Michigan Complete Health - home
Our Comprehensive Benefits Package:
-Flexible work solutions including remote options, hybrid work
schedules and dress flexibility
-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
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 New Hampshire and Massachusetts: Candidates with RN license in
good standing in other states than NH, must obtain a NH RN within
90 days of hire. Active driver 's license in good standing
For Arizona Complete Health - Complete Care Plan:
Obstetrics (OB) assignments requires RN experience in OB (clinical,
acute care, community)
Pediatric assignments require RN experience in pediatrics
(clinical, acute care, community)
For Michigan Complete Health: Licensed RN; licensed nurse
practitioner, licensed physician's assistant. Valid driver's
Valid driver 's license and proof of car insurance.
For North Carolina only: Care Managers, this individual shall be
responsible for conducting all functions and activities of the care
management program and serve as the lead for each care management
- Must reside in North Carolina
- Must be licensed practitioners
- Must be supervised by an RN, LCSW, or psychologist with
trauma-based experience and training.
- Note: Care Manager for medical services is a NC - Licensed
Registered Nurse in good standing. Care Manager for BH services in
NC - Licensed LCSW in good standing.
Behavioral Health (BH) Managers and Full-Time BH Staff: These
individuals shall be responsible for integrating into the clinical
and care management teams to ensure Member 's behavioral health
needs are fully integrated into the service delivery system.
- Must reside in North Carolina
- Experience working in behavioral health managed care and clinical
- Licensed behavioral health professional practicing within their
For Sunshine Health (FL) Only: Employees supporting Florida's
Children 's Medical Services (CMS) must have a minimum of two years
of pediatric experience.
For Oklahoma Complete Health Only: Employees may be required to be
on call. Employees will be required to make member visits.
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.
Keywords: Sunshine State Health Plan, Tallahassee , Pediatric RN Care Manager - Remote Available, Executive , Calvary, Florida
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