Case Manager (Urgent Search) Position Available In Miami-Dade, Florida

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Company:
Sunshine State Health Plan
Salary:
$79804
JobFull-timeOnsite

Job Description

Job Description:

You could be the one who changes everything for our 28 millionmembers. Centene is transforming the health of our communities, oneperson at a time. As a diversified, national organization, you’llhave access to competitive benefits including a fresh perspectiveon workplace flexibility.

Position Purpose:

Develops, assesses, andfacilitates complex care management activities for primarilyphysical needs members to provide high quality, cost-effectivehealthcare outcomes including personalized care plans and educationfor members and their families. This is a remote /field positioncandidate must reside in Miami Dade county for face to face visitsto members.

  • Evaluates the needs of the member, barriers toaccessing the appropriate care, social determinants of healthneeds, focusing on what the member identifies as priority andrecommends and/or facilitates the plan for the best outcome
  • Develops ongoing care plans / service plans and collaborates withproviders to identify providers, specialists, and/or communityresources to address member’s unmet needs
  • Identifiesproblems/barriers to care and provide appropriate care managementinterventions
  • Coordinates as appropriate between the memberand/or family/caregivers and the care provider team to ensuremembers are receiving adequate and appropriate person-centered careor services
  • Provides ongoing follow up and monitoring of memberstatus, change in condition, and progress towards care plan /service plan goals; collaborate with member, caregivers, andappropriate providers to revise or update care plan / service planas necessary to meet the member’s goals / unmet needs
  • Providesresource support to members and care managers for local resourcesfor various services (e.g., employment, housing, participantdirection, independent living, justice, foster care) based onservice assessment and plans, as appropriate
  • Facilitate caremanagement and collaborate with appropriate providers orspecialists to ensure member has timely access to needed care orservices
  • May perform telephonic, digital, home and/or other siteoutreach to assess member needs and collaborate with resources
  • Collects, documents, and maintains all member information and caremanagement activities to ensure compliance with current state,federal, and third-party payer regulators
  • Provides and/orfacilitates education to members and their families/caregivers ondisease processes, resolving care gaps, healthcare providerinstructions, care options, referrals, and healthcare benefits
  • Provides feedback to leadership on opportunities to improve andenhance care and quality delivery for members in a cost-effectivemanner
  • Other duties or responsibilities as assigned by peopleleader to meet business needs
  • Performs other duties as assigned
  • Complies with all policies and standards.
Education/Experience:

Requires a Degree from an Accredited School of Nursing or aBachelor’s degree in Nursing and 2

  • 4 years of related experience.
License/Certification:
  • RN•Registered Nurse•State Licensureand/or Compact State Licensure required•For Sunshine Health (FL)
Only:

Employees supporting Florida’s Children’s Medical Services(CMS) must have a minimum of two years of pediatric experience. Mayrequire up to 50% local travel required This is a remote /fieldposition candidate must reside in Miami Dade county for face toface visits to members. Bilingual Spanish speaking is highlypreferred.

Pay Range:

$55,100.00

  • $99,000.

00 per year Centeneoffers a comprehensive benefits package including: competitive pay,health insurance, 401K and stock purchase plans, tuitionreimbursement, paid time off plus holidays, and a flexible approachto work with remote, hybrid, field or office work schedules. Actualpay will be adjusted based on an individual’s skills, experience,education, and other job-related factors permitted by law,including full-time or part-time status. Total compensation mayalso include additional forms of incentives. Benefits may besubject to program eligibility. Centene is an equal opportunityemployer that is committed to diversity, and values the ways inwhich we are different. All qualified applicants will receiveconsideration for employment without regard to race, color,religion, sex, sexual orientation, gender identity, nationalorigin, disability, veteran status, or other characteristicprotected by applicable law. Qualified applicants with arrest orconviction records will be considered in accordance with the LACounty Ordinance and the California Fair Chance Act

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