Sunshine State Health Plan Looking for Care Manager II (RN) at Orange Park, FL Full Time

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.

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
• For New Hampshire, Massachusetts, & Michigan Complete Health – home visits required
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• 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 population
• Review and approve the initial and ongoing assessment and care plan to ensure requirements are met
• Coordinate service request/authorizations with UM and ensure agreement is aligned between the member, agency, and MCO
• Facilitate member linkages to MCO-based services and programs in collaboration w/ agency staff
• Assist members and/or agency staff w/ transportation to healthcare appointments
• Communicate status of member health indicators with agency staff that can contribute the successful community living of members
• Participate in weekly rounds w/ agency staff
• Other duties as assigned

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

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:

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:

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 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 setting
• Licensed 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.

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.