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Care Manager II (RN)

Company: Centene
Location: Scranton
Posted on: December 4, 2019

Job Description:

Care Manager II (RN) Position Purpose: 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 Education/Experience: 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. Clinical & Nursing USA-Pennsylvania-Scranton Pennsylvania Health & Wellness Full-time

Keywords: Centene, Scranton , Care Manager II (RN), Executive , Scranton, Pennsylvania

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