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Senior Care Manager (RN)

Company: Centene Coproration
Location: San Antonio
Posted on: November 11, 2019

Job Description:

Description: 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 knowledge, experience 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 desired outcomes 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 management plan Actively participate in integrated team care management rounds Identify related risk management quality concerns and report these scenarios to the appropriate resources 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 needed Case load will reflect heavier weighting of complex cases than Care Manager II, commensurate with experience Serve as a subject matter expert for questions or issues for other Utilization Review and Care Managers, Referral Specialists and Program Coordinators Audit case reviews to ensure compliance with case management policies and procedures and NCQA requirements Assist with the development of case management workflows, policies, and procedures Provide oversight to and assist with training of other case management staff For New Hampshire and Massachusetts - home visits required

Keywords: Centene Coproration, San Antonio , Senior Care Manager (RN), Healthcare , San Antonio, Texas

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