Care Manager II
Company: Centene Corporation
Posted on: May 19, 2019
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
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
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 neededQualification:
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
Licenses/Certifications\: Current state------s RN license
Centene 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.
Keywords: Centene Corporation, Fresno , Care Manager II, Executive , Fresno, California
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