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.
- This position is remote / field based with local travel required for member visits up to 80% of the time. Candidates should reside in Miami-Dade County, FL and hold licensure in the State of Florida to be considered. A minimum of two (2) years of pediatric experience is required.
Candidates must be willing to work one of the following schedules :
Tuesday - Saturday, 8 hours per day
Wednesday - Saturday, 10 hours per day
Position Purpose : Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.
Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and / or facilitates the plan for the best outcomeDevelops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and / or community resources to address member's unmet needsIdentifies problems / barriers to care and provide appropriate care management interventionsCoordinates as appropriate between the member and / or family / caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or servicesProvides ongoing follow up and monitoring of 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 member's goals / unmet needsProvides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriateFacilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or servicesMay perform telephonic, digital, home and / or other site outreach to assess member needs and collaborate with resourcesCollects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulatorsProvides and / or facilitates education to members and their families / caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefitsProvides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective mannerOther duties or responsibilities as assigned by people leader to meet business needsPerforms other duties as assigned.Complies with all policies and standards.Education / Experience : Requires a degree from an accredited school of nursing or a Bachelor's degree in nursing and 2 – 4 years of related experience.
License / Certification :
RN - Registered Nurse - State Licensure and / or Compact State Licensure requiredFor 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 requiredCentene 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
