Care Manager (RN) - J01007

• Degree from an accredited school of nursing or Bachelor's degree in Nursing
  
• 4-6 years of related experience
  

• Required: Registered Nurse (RN) with state licensure and/or Compact State licensure
  
• YouthCare Illinois Plan Only:
  
  • Bachelor's Degree required
    
  • Illinois RN licensure required
    
  • Must reside in Illinois
    
• Sunshine Health (Florida) Only:
  
  • Employees supporting Florida's Children's Medical Services (CMS) must have a minimum of two (2) years of pediatric experience
    
  • Up to 80% local travel may be required
    

• Develops and continuously assesses care plans/service plans and collaborates with providers to identify primary care providers, specialists, and/or community resources to address unmet member needs
  
• Coordinates and manages care between members, families/caregivers, and provider teams to ensure delivery of adequate, appropriate, and person-centered care
  
• Monitors member status, changes in condition, and progress toward care plan goals; collaborates with members, caregivers, and providers to revise care plans as needed
  
• Identifies problems or barriers to care management and implements appropriate interventions for escalated cases
  
• Reviews member data to identify trends and improve operational performance and quality of care in compliance with state and federal regulations
  
• Reviews referral information and intake assessments to develop appropriate care/service plans
  
• Conducts telephonic, digital, home, and/or site-based outreach to assess member needs and collaborate with resources
  
• Collaborates with healthcare providers to facilitate services, treatments, and revisions to care plans when necessary
  
• Collects, documents, and maintains all care management activities to ensure compliance with state, federal, and third-party payer regulations
  
• Provides and/or facilitates education for members and families/caregivers regarding disease processes, care gaps, provider instructions, referrals, care options, and healthcare benefits
  
• Partners with leadership to improve care delivery and quality outcomes in a cost-effective manner
  
• May precept and mentor clinical new hires by coaching, facilitating skill development, and guiding onboarding and readiness
  
• Provides support to new hires in navigating a Managed Care Organization (MCO), including coaching, shadowing, and bridging classroom learning to field practice
  
• Engages with People Leaders and cross-functional teams to measure and monitor readiness and performance
  
• Performs other duties as assigned to meet business needs
  
• Complies with all organizational policies and standards
  

• This team supports anticipated substantial growth in Medicaid membership effective January 1, 2025
  
• The Care Manager will work alongside a team of Case Managers focused on adult members with chronic conditions, including Diabetes, Hypertension, and Congestive Heart Failure
  
• This position is part of a larger hiring initiative
  

• Following a one-month orientation, the Care Manager will be precepted and fully supported by teammates and leadership
  
• The role requires comfort with cold-calling members who have been hospitalized or identified as needing case management
  
• Social Determinants of Health (SDOH) are addressed to help members overcome barriers impacting physical health
  
• Caseload expectation: 50 members with an average length of stay of 90 days
  
• Performance metric: Monthly audit score of 90% or higher (current team average is 99%)
  
• Fully remote role; Centene provides laptop, docking station, two monitors, keyboard, mouse, and computer-based calling system
  

• Required: Graduation from an accredited nursing program or Bachelor's degree
  
• Preferred: Certified Case Manager (CCM)
  

• Required: Registered Nurse (RN)
  

• Required: Five (5) or more years of adult nursing experience
  
• Home care RN experience has historically been successful in this role
  

• Less than five (5) years of experience
  
• No adult nursing experience
  

• Dedicated, private home office space with desk, chair, and door to ensure confidentiality
  
• Strong basic computer and typing skills
  
• Excellent verbal and written communication skills
  
• Basic Excel and Word skills, including viewing and editing documents
  
• Ability to work independently while appropriately seeking assistance
  

Interested candidates please send resume in Word format Please reference job code 249778 when responding to this ad.