Care Manager II

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering 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.

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 optionsUtilize 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 outcomesCoordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clientsProvide patient and provider educationFacilitate member access to community based servicesMonitor referrals made to community based organizations, medical care and other services to support the members’ overall care management planActively participate in integrated team care management roundsIdentify 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 experienceEnter and maintain assessments, authorizations, and pertinent clinical information into various medical management systemsDirect care to participating network providersPerform 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 neededFor New Hampshire, Massachusetts, & Michigan Complete Health - home visits required

Additional Requirements For LHCC (LA) For Only DOJ Positions

Each position will be the delegated agency’s single point of contact to coordinate the overall CM activities provided to the target populationReview and approve the initial and ongoing assessment and care plan to ensure requirements are metCoordinate service request/authorizations with UM and ensure agreement is aligned between the member, agency, and MCOFacilitate member linkages to MCO-based services and programs in collaboration w/ agency staffAssist members and/or agency staff w/ transportation to healthcare appointmentsCommunicate status of member health indicators with agency staff that can contribute the successful community living of membersParticipate in weekly rounds w/ agency staffOther duties as assigned

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 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.

Licenses/Certifications Current state’s RN license.

Texas Requirements

Education/Experience Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing or case management experience in a clinical, acute care, managed care or community setting. 2+ years experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs. Other state specific requirements may apply.

Licenses/Certifications Current state’s RN license.

For New Hampshire Healthy Families Candidates with active RN license in good standing in other states than NH, must obtain the NH RN equi within 90 days of hire. Active driver’s license in good standing preferred. CCM preferred.

For Arizona Complete Health - Complete Care plan Pediatrics assignments require 2+ years’ RN experience in pediatrics (clinical acute care, community or managed care setting) and 1+ year experience in care management

Obstetrics (OB) assignments require 2+ years’ RN experience in OB (clinical, acute, community or managed care setting) and 1+ year experience in care management

Licenses/Certifications Current state’s RN license.

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.

Licenses/Certifications Current state’s RN license.

For Michigan Complete Health Licensed registered nurse; licensed nurse practitioner; licensed physician's assistant. Valid driver's license required.

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 teams.

Must reside in North CarolinaMust be licensed practitionersMust 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 CarolinaExperience working in behavioral health managed care and clinical settingLicensed behavioral health professional practicing within their scope

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.

For Shared Services Clinical licensure for multiple states is required.

For Illinois Youth Care contract Required Education/Experience – Bachelor’s Degree in nursing and RN licensure required. Two plus years of clinical experience required. For Illinois YouthCare plan only Candidates are required to live within the specified region.

For Oklahoma Complete Health Only Registered nurse with a license to practice in the State of Oklahoma. Must successfully complete the Behavioral Health Case Manager certification training provided through the Department of Mental Health and Substance Abuse Services within (6) months of date of hire.Pay Range $67,400.00 - $121,300.00 per year

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. Total compensation may also include additional forms of incentives.

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.