Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: For use by Arizona, Superior, and Sunflower only.


Develops, assesses and coordinates holistic care management activities, with primary focus and support towards the most complex or high risk/high acuity populations with primarily medical/physical health needs, to enable quality, cost-effective healthcare outcomes. Performs assessments, develops personalized care plans/service plans, and educates members, their families and caregivers on services and benefits available to meet member needs.

(Ohau Hawaii)

• Evaluates the medical, behavioral and social needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome
• Completes assessments related to medical/physical health needs such as airway management, artificial hydration/nutrition, seizure interventions, medication administration, etc., in addition to functional assessments and assessments of general health and social status
• Acts as liaison and member advocate between the member/family, physician, and facilities/agencies. Performs more frequent home and/or other visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required
• Supports members with complex medical needs that may place populations at greater risk for potentially preventable events, such as avoidable admissions, readmissions, and emergency room visits. (e.g., HIV/AIDS, cancer, COPD, hemophilia, sickle cell disease, brain injury)
• Develops, monitors and modifies ongoing long-term care plans/service plans, to include skilled and/or long-term nursing service needs
• Monitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicable
• Ensures appropriate referrals based on individual member needs and supports the identification of providers, specialists, and community resources. Ensures identified services are accessible to members
• Provides and/or facilitates education to long-term care members and their families/caregivers on topics such as preventive care, procedures, healthcare provider instructions, treatment options, referrals, prescribed medication treatment regimens, and healthcare benefits
• Educates on and coordinates community resources, to include medical, behavioral and social services. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living)
• Maintains accurate documentation and supports the integrity of care management activities in the electronic care management system; works to ensure compliance with clinical guidelines as well as current state and federal guidelines
• Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 2 - 4 years of related experience

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required or
• NP - Nurse Practitioner - Current State's Licensure required
• For Superior: Resource Utilization Group (RUG) certification must be obtained within 90 days of hire required

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

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.

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