Clinical – Senior Care Manager (RN) – J01044 Senior Care Manager (RN) – J01044 Position Available In [Unknown county], South Carolina

Clinical

• Senior Care Manager (RN)
• J01044 Senior Care Manager (RN)
• J01044#25-62103
  Various, SC
  All On-site Job Description

Job Description:

Position Purpose:

Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care.

Education/Experience:

Requires a Degree from an Accredited School or Nursing or a Bachelor’s degree in Nursing and 4

• 6 years of related experience.

License/Certification:

RN

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

For Illinois Youth Care Contract:

Bachelor’s degree in nursing requiredDevelops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member’s unmet needs Coordinates 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 Monitors 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 / unmet needs May identify problems/barriers for care management and appropriate care management interventions for escalated cases Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations Reviews referrals information and intake assessments to develop appropriate care plans/service plans May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care 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 Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness Provides 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 Engages and assists New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness Other duties or responsibilities as assigned by people leader to meet business needs
Performs other duties as assigned Complies with all policies and standards
Comments for

Vendors:

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of

• Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.” =======
  Centene Job Description
  Story Behind the Need
• Business Group & Key Projects Health plan or business unit
  Team culture
  Surrounding team & key projects
  Purpose of this team
  Reason for the request
  Motivators for this need
  Any additional upcoming hiring needs?

Absolute Total Care
Transition of Care Case Management for Medicaid members
This is a position to work the Medicaid LOB and assist in closing HEDIS care gaps and increase STAR ratings. Typical Day in the Role Daily schedule & OT expectations
Typical task breakdown and rhythm
Interaction level with team
Work environment description 8a-5p, NO OT
To complete care assessment after a hospitalization and provide case management services as needed to members.
High level of team interaction via email and chats
Hard working, great communication between the team Compelling Story & Candidate Value Proposition What makes this role interesting?
Points about team culture
Competitive market comparison
Unique selling points
Value added or experience gained This person will working remote and may also need to travel to see members.
(SEE ABOVE)
N/A
Working with a great team who works closely together to help meet goal Candidate Requirements
Education/Certification

Required:

Bachelor’s Degree, Licensed ( SEE

BOTTOM OF 2

nd

PAGE OF FORM FOR ADDITIONAL INFO TO REFERENCE

)

Preferred:

Master’s Degree
Licensure

Required:

Licensed Health Provider

Preferred:

N/A Years of experience required
Disqualifiers
Best vs. average
Performance indicators Must haves: Must have the licensed requirements sent in, Must reside in SC and MUST be willing to travel (25% of the time); 2+ years as a licensed health provider Nice to haves: Case Management experience

Disqualifiers:

Performance indicators: Outreaches to members after discharge from hospitalizations within 10 business days of discharge Best vs.

average:

Top 3 must-have hard skills
Level of experience with each
Stack-ranked by importance
Candidate Review & Selection 1 2+ years of clinical experience of psychiatric/mental health
2 Great computer skills and knowledge of navigating systems
3 Commitment 4 Software skills (MS Office, Word, Excel, Teams) 5 Candidate Review & Selection Shortlisting process
Second touchpoint for feedback
Interview Information

Onboard Process and Expectations Projected HM Candidate Review Date:

48 business hours

Number and Type of Interviews:

Interview w/ Sharon Hamilton, and 1-2 other managers
Extra Interview Prep for

Candidate:

No
Required Testing or Assessment (by Vendor): No
Manager Communication Preferences & Steps Background Check Requirements (List DFPS or other specialty checks here) Regular Do you have any upcoming PTO? No Colleagues to cc/delegate

TBD IMPORTANT COMPLIANCE NOTES FOR SUPPLIERS

• Sub-contracting is not permitted.
• Contacting a hiring leader directly about a requisition or hiring need is not permitted.
• The terms of the Staffing Services Agreement with Centene govern all assignments through the Centene Flex Workforce Solutions Program. Posting Centene’s (or its subsidiaries’) names, logos, or branding on public-facing sites is strictly prohibited.
• All contractors must sign a Temporary Worker Acknowledgement which must then be uploaded into Beeline by the vendor during the background check acceptance.

More information on the above policies can be found in your Supplier Manual. If you have any questions, please reach out to CenteneFlexWorkforceSolutions@Centene.com Addition information on requirements for the person. Can be any of the following:
Per

HEDIS 2025

Appendix 3, a provider who delivers mental health services and meets any of the following criteria:
An MD or doctor of osteopathy (DO) who is certified as a psychiatrist or child psychiatrist by the American Medical Specialties Board of Psychiatry and Neurology or by the American Osteopathic Board of Neurology and Psychiatry; or, if not certified, who successfully completed an accredited program of graduate medical or osteopathic education in psychiatry or child psychiatry and is licensed to practice patient care psychiatry or child psychiatry, if required by the state of practice.
An individual who is licensed as a psychologist in their state of practice, if required by the state of practice.
An individual who is certified in clinical social work by the American Board of Examiners; who is listed on the National Association of Social Worker’s Clinical Register; or who has a master’s degree in social work and is licensed or certified to practice as a social worker, if required by the state of practice.
A registered nurse (RN) who is certified by the American Nurses Credentialing Center (a subsidiary of the American Nurses Association) as a psychiatric nurse or mental health clinical nurse specialist, or who has a master’s degree in nursing with a specialization in psychiatric/ mental health and 2 years of supervised clinical experience and is licensed to practice as a psychiatric or mental health nurse if required by the state of practice.
An individual (normally with a master’s or a doctoral degree in marital and family therapy and at least 2 years of supervised clinical experience) who practices as a marital and family therapist and is licensed as a certified counselor by the state of practice, or, if licensure or certification is not required by the state of practice, who is eligible for clinical membership in the American Association for Marriage and Family Therapy.
An individual (normally with a master’s or doctoral degree in counseling and at least 2 years of supervised clinical experience) who practices as a professional counselor, and is licensed or certified to do so by the state of practice, or, if licensure or certification is not required by the state of practice, is a National Certified Counselor with a Specialty Certification in Clinical Mental Health Counseling from the National Board for Certified Counselors.
A physician assistant who is certified to practice psychiatry by the National Commission on Certification of Physician Assistants.
A certified community mental health center (CMHC), or the comparable term (e.g., behavioral health organization, mental health agency, behavioral health agency) used in the state of location, or a Certified Community Behavioral Health Clinic (CCBHC).
Only authorized CMHCs are considered mental health providers. To be authorized as a CMHC, an entity must meet one of the following criteria:
The entity has been certified by CMS to meet the conditions of participation (CoPs) that community mental health centers (CMHCs) must meet in order to participate in the Medicare program, as defined in the Code of Federal Regulations Title 42. CMS defines a CMHC as an entity that meets applicable licensing or certification requirements for CMHCs in the State in which it is located and provides the set of services specified in section 1913(c)(1) of the Public Health Service Act (PHS Act).
The entity has been licensed, operated, authorized, or otherwise recognized as a CMHC by a state or county in which it is located.
Only authorized CCBHCs are considered mental health providers. To be authorized as a CCBHC, an entity must meet one of the following criteria:
Has been certified by a State Medicaid agency as meeting criteria established by the Secretary for participation in the Medicaid CCBHC demonstration program pursuant to Protecting Access to Medicare Act
Being is a RN is not the only people considered for the job