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Care Manager II - RN - Med Surg

Company: Centene Corporation
Location: Mcallen
Posted on: January 27, 2023

Job Description:

Care Manager II - RNYou could be the one who changes everything for our 26 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.

100% REMOTE IN TEXAS - Applicants must be fully licensed Registered Nurse (RN) for the state of Texas

As a Care Manager RN, you will:

Perform telephonic 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.

* Telephonically 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
* 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
* Other duties as assigned

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.

Preferred Experience:

* 5+ years of clinical nursing experience working with children, adolescent, and adults with complex medical conditions.


* work experience in any of the following settings: acute care, long-term care, community clinics, home health, assisted living, skilled nursing facilities, nursing rehab, private duty nursing, and/or school-based settings.


* 1+ years of case management and/or medical healthcare service coordination


* Direct managed care experience is a PLUS



Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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: Centene Corporation, McAllen , Care Manager II - RN - Med Surg, Executive , Mcallen, Texas

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