Centene Corp

Lead Care Manager (RN)

Centene Corp$87K — $161K *
US-AnywhereRemote in Florida, US
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Degree from an Accredited School of Nursing or Bachelor's degree in Nursing
  • 5-7 years of related experience
  • Active RN - Registered Nurse - State Licensure and/or Compact State Licensure required
  • Experience in a call center environment is a plus
  • Specialty pharmacy experience preferred

Responsibilities

  • Oversee and review care plans and collaborate with providers.
  • Provide insights on developing care plans and triaging issues.
  • Guide care management team to ensure quality control and adherence to standards.
  • Monitor member status and revise care plans as necessary.
  • Provide subject matter expertise to enhance member care.
  • Work with senior management on complex cases and guide junior team members.
  • Perform outreach to assess member needs and collaborate with resources.

Benefits

  • Remote work opportunity
  • Training and education for team and providers
  • Collaborative work environment
  • Opportunities for professional development
  • Compliance training with healthcare standards
Full Job Description

Position Purpose: Oversees the care plans / service plans and care management activities of member needs to provide quality, cost-effective healthcare outcomes. Reviews and provides expert knowledge to inform personalized care plans / service plans for complex care members and provides guidance and/or support to the care management team.

Key Details: Seeking remote RN (speciality pharmacy experience a plus) to work in an Inbound/Outbound Call Center Environment.

  • Oversees and reviews ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources needed to address member's unmet needs
  • Provides insight and guidance on developing care plans / service plans and triaging issues to appropriate healthcare providers for care plans / service plans
  • Provides guidance and expert knowledge as appropriate to care management team members to ensure quality control over work, members are receiving needed care or services, and adherence to contract policies and procedures
  • Monitors the care plans / service plans and/or member status and outcomes or changes in condition, and revises care plan based on member needs and issues identified
  • Provides subject matter expertise insights for care plans / service plans based on prior experience to recommend enhanced member care within the care management plan
  • Works with senior management on escalated and complex care cases, and provides guidance to junior team members to address member concerns
  • May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
  • Reviews member data to identify health risks and or care gaps, collaborate with providers / specialists as appropriate to address member’s needs / issues
  • Monitors management policies and procedures within the care management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
  • Partners and collaborates with healthcare providers as appropriate to facilitate member’s treatments to ensure member service / care needs are met and determine a revised care plan / service plan for member if needed
  • Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
  • Works as a subject matter expert (SME) and provides training and education to care management team and providers to ensure members are receiving high quality care and information regarding care plan / service plan options, procedures, referrals, and healthcare benefits
  • Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner
  • Performs 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 5 – 7 years of related experience.

License/Certification:

  • RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Pay Range: $87,000.00 - $161,300.00 per year

About Centene Corp

Centene Corporation is a managed healthcare enterprise at the forefront of innovation and growth for government-sponsored and commercial healthcare, providing access to fully integrated, high-quality, and cost-effective services that help people lead healthier lives. The company’s local approach addresses the needs of under-insured and uninsured individuals who often lack the resources required to sustain optimal health and wellness. Centene began as a single health plan in Milwaukee, Wisconsin in 1984. After an initial period of growth, Michael Neidorff joined as President and Chief Executive Officer (CEO) in 1996, moving Centene’s headquarters to St. Louis, Missouri, where it still resides today. In the decades since its humble beginnings, Centene has transformed into a publicly-traded Fortune 500 company serving communities across the United States. In fact, Centene provides coverage in all 50 U.S. states. More than 26 million Americans rely on Centene to access a wide range of insurance solutions, including Medicaid, Medicare, TRICARE, correctional, and behavioral health services. Centene prioritizes the development of technology that addresses systemic conditions impacting the whole health needs of underserved populations. As technology plays an increasingly critical role in diagnosing, managing, and treating disease, Centene understands that it enables better health outcomes for members, lessening the burden for providers, and allowing more automation and efficiency for business operations. As a steward of a significant set of data and insights, Centene leverages this data to not only shape but lead the digital transformation of healthcare and improve the patient-provider experience. Centene’s current CEO, Sarah London, and her team are leading the charge in this new age. Sarah London worked within Centene’s Technology Innovation and Modernization division, spearheading the company’s enterprise-wide technology strategy. Now leading Centene, her focus is on building the next generation of products and services and establishing Centene’s long-term growth and value creation. Although Centene has grown into the No. 1 insurer in the U.S. Health Insurance Marketplace, it has never lost its focus on the individual or its passion for community health. Remaining connected to the individuals and families that need care most is central to Centene’s commitment to shaping a better world of healthcare for the communities it serves. Centene also remains connected to the needs of its employees, who make Centene what it is. Through its commitment to diversity, equity, and inclusion practices, Centene promotes a safe and inviting environment above all. Because of Centene’s commitment to excellence and progression in the healthcare industry, it has been recognized as a Top Organization for Diversity by Modern Healthcare magazine, a Leading Disability Employer by the National Organization on Disability, a Best Place to Work for LGBTQ Equality by The Human Rights Campaign Foundation, and a global leader by Bloomberg’s Gender-Equality Index, among many other recognitions. Centene was also named a Top 50 Company for Diversity by DiversityInc and a Top Veteran-Friendly Company by U.S. Veterans Magazine. It has also been listed on FORTUNE® magazine's list of the World's Most Admired Companies for several consecutive years.

Centene Corp Careers

Join the dynamic team at Centene Corp, a leader in the healthcare industry, where your career growth and development are prioritized. At Centene Corp, we offer a range of job opportunities that allow you to make a significant impact on our community and beyond.

Explore a World of Opportunities

Discover the diverse career paths available at Centene Corp, from healthcare services to innovative program development. Our job opportunities span various professional fields, offering positions that cater to your unique skills and ambitions. Whether you're looking for an entry-level role or a senior leadership position, Centene Corp is committed to hiring top talent and fostering a culture of excellence.

Innovation and Leadership at Centene Corp

At Centene Corp, innovation and leadership go hand in hand. We empower our team members to lead with confidence and creativity, driving the company forward through strategic innovation and robust leadership. Our leadership programs are designed to cultivate your skills, helping you to thrive as a professional and make meaningful contributions to our company and the communities we serve.

Internships and Early Career Programs

Kickstart your career with Centene Corp through our internship and early career programs. These opportunities provide hands-on experience and a glimpse into the dynamic world of healthcare management. Internships at Centene Corp are a stepping stone to full-time employment, offering invaluable networking opportunities, mentorship, and the chance to develop your resume and interview skills in a real-world setting.

Commitment to Diversity and Inclusive Culture

Centene Corp is dedicated to maintaining a diverse and inclusive work environment. We believe that diversity fuels innovation and enhances our team's performance. Our diversity training ensures that all team members appreciate and leverage the broad range of experiences and perspectives that each individual brings to the company.

Benefits and Employee Growth

We value our employees' well-being and career aspirations. Centene Corp offers competitive benefits, including health insurance, retirement plans, and professional development programs. Our commitment to your growth is reflected in our continuous learning initiatives and performance management processes that help you achieve your career goals.

Join Our Team

Are you ready to advance your career at Centene Corp? Explore our current job openings and find the position that best matches your skills and interests. We are looking for passionate, curious, and solution-driven team players who are ready to make a difference.

Stay Connected with Centene Careers

Keep up to date with the latest career tips, insider perspectives, and industry-leading insights—all from the people who work at Centene Corp. Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding opportunities that await you at Centene Corp.

SEARCH CENTENE JOBS

Centene Corp is not just a company—it's a place where you can shape your future and impact the lives of millions. Join us in our mission to transform the health of the community, one person at a time.
Learn more about Centene Corp
Size
72,500 employees
Market Cap
$46.5 billion
Industry
Net Income
$1.8 billion
Founded
1984
5 Year Trend
+25.4%
Revenue
$111.1 billion
NASDAQ

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