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Job description
Position Purpose:
nPerforms care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical 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 families/caregivers on services and benefit options available to receive appropriate high-quality care.
nKey Details: This is a hybrid role performing in person assessments. The service delivery area is the Harlingen, Mercedes, Weslaco area.
nnnEvaluates the service needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome
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nnDevelops and continuously assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed to address member's needs
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nnCoordinates and manages 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 services
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nnMonitors care plans / service plans and/or 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 / needs
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nnMonitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicable
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nnReviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
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nnReviews referrals information and intake assessments to develop appropriate care plans / service plans
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nnCollaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed
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nnCollects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines
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nnProvides and/or facilitates education to long-term care members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
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nnActs as liaison and member advocate between the member/family, physician, and facilities/agencies
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nnEducates 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)
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nnMay perform home and/or other site visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required
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nnPartners with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
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nnMay precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness
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nnMay provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice
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nnMay engage and assist New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
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nnEngages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
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nnPerforms other duties as assigned
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nnComplies with all policies and standards
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n nEducation/Experience: Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 4–6 years of related experience
nBachelor's degree in Nursing preferred
nLicense/Certification:
nnnRN - Registered Nurse - State Licensure and/or Compact State Licensure required or
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nnNP - Nurse Practitioner - Current State's Nurse Licensure required
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nnResource Utilization Group (RUG) certification must be obtained within 90 days of hire required
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n nPay Range: $36.21 - $65.09 per hour
nAt Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
nCentene 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.
nCentene 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.
nQualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Worksite address
weslaco, TX, 78596, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.