Job Description
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.
**Pediatric RN - local travel in Austin, TX is required for member visits 3
days per week.**
**Position Purpose:** Performs care management duties to assess and coordinate
all aspects of medical and supporting services across the continuum of care
for complexhigh acuity populations with primary medicalphysical health needs
to promote quality, cost effective care. Develops a personalized care plan
service plan for long-term care members, addresses issues, and educates
members and their familiescaregivers on services and benefit options
available to receive appropriate high-quality care.
- Evaluates the service needs of the most complex or high riskhigh acuity members and recommends a plan for the best outcome
- Develops and continuously assesses ongoing long-term care plans service plans and collaborates with care management team to identify providers, specialists, andor community resources needed to address members needs
- Coordinates and manages as appropriate between the member andor familycaregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
- Monitors care plans service plans andor 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 members goals needs
- Monitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care andor waiver eligibility, as applicable
- 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
- Collaborates with healthcare providers as appropriate to facilitate member services andor 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 clinical guidelines
- Provides andor facilitates education to long-term care members and their familiescaregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
- Acts as liaison and member advocate between the memberfamily, physician, and facilitiesagencies
- Educates on and coordinates community resources. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living)
- May perform home andor other site visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required
- Partners with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
- May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness
- May provide guidance and support to clinical new hirespreceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice
- May engage and assist New HirePreceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
- Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
- Performs other duties as assigned
- Complies with all policies and standards
- Travel is required for member visits
- *EducationExperience:** Requires Graduate from an Accredited School of
Nursing or a Bachelors degree and 4–6 years of related experience
Bachelors degree in Nursing preferred
- *LicenseCertification:**
- RN - Registered Nurse - State Licensure andor Compact State Licensure required or
- NP - Nurse Practitioner - Current States Nurse Licensure required
- For Superior: Resource Utilization Group (RUG) certification must be obtained within 90 days of hire required
- *Preferred Experience:**
- Clinical RN nursing experience with direct patient care andor administering medically approved Medicaid assessment and providing case management and coordinating referrals for medical services
- Pediatrics, NICU, PICU, Pediatric ER
- Pediatrics PDN
- School Nurse
- Home Health or Hospice experience
- Case Management
- Service Coordination for medical services
Pay Range: $34.81 - $62.54 per hour
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
individuals 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.
Qualified applicants with arrest or conviction records will be considered in
accordance with the LA County Ordinance and the California Fair Chance Act
Job Tags
Hourly pay, Holiday work, Full time, Local area, Remote job, Flexible hours,