Raleigh, North CarolinaApply NowJob ID Category Government RelationsOrganization Carolina Complete HealthSchedule Full-time Description:Position Purpose: Serve as a liaison to state government entities to improve the legislative and regulatory environment for the state health plan and Centene Corporation Assist with the development of state legislative public policy concerning state insurance, Managed Care Organization and Medicare and Medicaid regulations through the initiatives of state legislators and their staff Develop strategic relationships with state legislative policymakers to enhance the health plan and Centene's role as a partner with the state and to assist in shaping public policy initiatives Identify, evaluate and analyze the impact of state legislative and regulatory issues for state health plan and Centene Corporation and advise management concerning their impact Represent and serve as point person for the state health plan and Centene Corporation to outside trade groups/stakeholders including state AHIP organization, state medical association, state hospital association and related Medicare and Medicaid business vendors Represent state health plan and Centene Corporation to state legislators and their staffs Develop and shape legislative policies and strategies through relevant coalitions and issue advocacy campaigns Balance reporting requirements to multiple constituencies including; Centene Corporation regional vice president, state health plan president, chief operating officers and Corporate regulatory and government affairs staff Qualifications:Education/Experience: Bachelor's degree in Public Policy, Government Affairs, Business Administration or equivalent experience. Master's or Law degree preferred. 5 years of related experience. Extensive knowledge of state legislative and regulatory processes. Experience with state legislature, health care trade associations including America's Health Insurance Plans (AHIP), National Association of Insurance Commissioners (NAIC) and federal and state Medicare and Medicaid laws and regulations. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. 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. Search for a category, location, or category/location pair, select from the suggestions and click "Add". Our local approach allows us to help members access high-quality, culturally sensitive healthcare services.
Mar 18, 2019
Full time
Raleigh, North CarolinaApply NowJob ID Category Government RelationsOrganization Carolina Complete HealthSchedule Full-time Description:Position Purpose: Serve as a liaison to state government entities to improve the legislative and regulatory environment for the state health plan and Centene Corporation Assist with the development of state legislative public policy concerning state insurance, Managed Care Organization and Medicare and Medicaid regulations through the initiatives of state legislators and their staff Develop strategic relationships with state legislative policymakers to enhance the health plan and Centene's role as a partner with the state and to assist in shaping public policy initiatives Identify, evaluate and analyze the impact of state legislative and regulatory issues for state health plan and Centene Corporation and advise management concerning their impact Represent and serve as point person for the state health plan and Centene Corporation to outside trade groups/stakeholders including state AHIP organization, state medical association, state hospital association and related Medicare and Medicaid business vendors Represent state health plan and Centene Corporation to state legislators and their staffs Develop and shape legislative policies and strategies through relevant coalitions and issue advocacy campaigns Balance reporting requirements to multiple constituencies including; Centene Corporation regional vice president, state health plan president, chief operating officers and Corporate regulatory and government affairs staff Qualifications:Education/Experience: Bachelor's degree in Public Policy, Government Affairs, Business Administration or equivalent experience. Master's or Law degree preferred. 5 years of related experience. Extensive knowledge of state legislative and regulatory processes. Experience with state legislature, health care trade associations including America's Health Insurance Plans (AHIP), National Association of Insurance Commissioners (NAIC) and federal and state Medicare and Medicaid laws and regulations. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. 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. Search for a category, location, or category/location pair, select from the suggestions and click "Add". Our local approach allows us to help members access high-quality, culturally sensitive healthcare services.
Description: Position Purpose\: Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations and act as trainer and mentor to less experienced staff. Provide technical support to staff and provide ongoing training. Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and the responsibility. Process referrals and refer, when appropriate to Case Managers. Screen for eligibility and benefits. Answer phone queues and faxes within established standards. Data enters authorizations into the system. Qualification: Education/Experience\: High school Diploma or equivalent. Bilingual in Spanish preferred. 3+ years of customer service experience. Knowledge of medical terminology preferred.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.
Mar 18, 2019
Full time
Description: Position Purpose\: Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations and act as trainer and mentor to less experienced staff. Provide technical support to staff and provide ongoing training. Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and the responsibility. Process referrals and refer, when appropriate to Case Managers. Screen for eligibility and benefits. Answer phone queues and faxes within established standards. Data enters authorizations into the system. Qualification: Education/Experience\: High school Diploma or equivalent. Bilingual in Spanish preferred. 3+ years of customer service experience. Knowledge of medical terminology preferred.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.
Description: Position Purpose: Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care Conduct discharge planning Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems For New Hampshire and Massachusetts - home visits required Qualifications: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Acute care experience preferred Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's LPN/LVN or 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.
Mar 17, 2019
Full time
Description: Position Purpose: Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care Conduct discharge planning Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems For New Hampshire and Massachusetts - home visits required Qualifications: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Acute care experience preferred Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's LPN/LVN or 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.
Description: Position Purpose: Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility. Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census. Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Screen members by priority for case management (CM) assessment. Perform transition of care duties to include but not limited to, contact the member's attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs. Coordinate services with community based organizations. Attend marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material. Data enter assessments and authorizations into the system.
Mar 17, 2019
Full time
Description: Position Purpose: Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility. Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census. Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Screen members by priority for case management (CM) assessment. Perform transition of care duties to include but not limited to, contact the member's attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs. Coordinate services with community based organizations. Attend marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material. Data enter assessments and authorizations into the system.
Description: Position Purpose: · Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations· Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings· Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care· Conduct discharge planning· Educate providers on utilization and medical management processes· Provide clinical knowledge and act as a clinical resource to non-clinical team staff· Enter and maintain pertinent clinical information in various medical management systems Qualifications: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Acute care experience preferred Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's LPN/LVN or 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.
Mar 16, 2019
Full time
Description: Position Purpose: · Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations· Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings· Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care· Conduct discharge planning· Educate providers on utilization and medical management processes· Provide clinical knowledge and act as a clinical resource to non-clinical team staff· Enter and maintain pertinent clinical information in various medical management systems Qualifications: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Acute care experience preferred Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's LPN/LVN or 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.
Description: Position Purpose: · Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations· Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings· Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care· Conduct discharge planning· Educate providers on utilization and medical management processes· Provide clinical knowledge and act as a clinical resource to non-clinical team staff· Enter and maintain pertinent clinical information in various medical management systems Qualifications: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Acute care experience preferred Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's LPN/LVN or 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.
Mar 16, 2019
Full time
Description: Position Purpose: · Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations· Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings· Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care· Conduct discharge planning· Educate providers on utilization and medical management processes· Provide clinical knowledge and act as a clinical resource to non-clinical team staff· Enter and maintain pertinent clinical information in various medical management systems Qualifications: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Acute care experience preferred Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's LPN/LVN or 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.
Description: Position Purpose: · Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations· Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings· Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care· Conduct discharge planning· Educate providers on utilization and medical management processes· Provide clinical knowledge and act as a clinical resource to non-clinical team staff· Enter and maintain pertinent clinical information in various medical management systems Qualifications: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Acute care experience preferred Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's LPN/LVN or 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.
Mar 16, 2019
Full time
Description: Position Purpose: · Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations· Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings· Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care· Conduct discharge planning· Educate providers on utilization and medical management processes· Provide clinical knowledge and act as a clinical resource to non-clinical team staff· Enter and maintain pertinent clinical information in various medical management systems Qualifications: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Acute care experience preferred Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's LPN/LVN or 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.
Description: Position Purpose: · Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations· Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings· Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care· Conduct discharge planning· Educate providers on utilization and medical management processes· Provide clinical knowledge and act as a clinical resource to non-clinical team staff· Enter and maintain pertinent clinical information in various medical management systems Qualifications: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Acute care experience preferred Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's LPN/LVN or 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.
Mar 16, 2019
Full time
Description: Position Purpose: · Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations· Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings· Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care· Conduct discharge planning· Educate providers on utilization and medical management processes· Provide clinical knowledge and act as a clinical resource to non-clinical team staff· Enter and maintain pertinent clinical information in various medical management systems Qualifications: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Acute care experience preferred Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's LPN/LVN or 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.
Description: Position Purpose\:? Oversee the development and implementation of operational processes within customer and patient services in alignment with the company???s business strategy, core values and company vision.? Oversee the customer and patient services department and generate value proposition for clients Develop, maintain, and ensure production and quality standards, such as response and call handle times, are met and audit outcomes Maintain appropriate staffing to ensure service levels are met across all product segments, smooth transition for new customers, and minimal impact to existing customers Evaluate systems, policies, and procedures, and drive changes to accomplish the organization???s and departments??? objectives Maintain strong internal control procedures in order to safeguard company assets Assist in the solution of problems that affect the service, efficiency, and productivity of the teamQualification: Education/Experience\: Bachelor's degree or equivalent experience. 8+ years of related healthcare experience, preferably in a patient services call center. Previous experience managing cross functional teams on large scale projects and management experience including hiring, training, assigning work and managing the performance of staff.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. ? #LI-ARI
Mar 16, 2019
Description: Position Purpose\:? Oversee the development and implementation of operational processes within customer and patient services in alignment with the company???s business strategy, core values and company vision.? Oversee the customer and patient services department and generate value proposition for clients Develop, maintain, and ensure production and quality standards, such as response and call handle times, are met and audit outcomes Maintain appropriate staffing to ensure service levels are met across all product segments, smooth transition for new customers, and minimal impact to existing customers Evaluate systems, policies, and procedures, and drive changes to accomplish the organization???s and departments??? objectives Maintain strong internal control procedures in order to safeguard company assets Assist in the solution of problems that affect the service, efficiency, and productivity of the teamQualification: Education/Experience\: Bachelor's degree or equivalent experience. 8+ years of related healthcare experience, preferably in a patient services call center. Previous experience managing cross functional teams on large scale projects and management experience including hiring, training, assigning work and managing the performance of staff.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. ? #LI-ARI
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 Develop, assess and adjust, as necessary, the care plan and promote desired outcome 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 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 Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs 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 For LTSS - 30% travel to perform home visits to members For New Hampshire, Massachusetts, & Michigan Complete Health - home visits required Qualifications: 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. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's RN license. For New Hampshire and Massachusetts: Valid driver's license For Arizona Complete Health - Complete Care Plan: Obstetrics (OB) assignments requires RN experience in OB (clinical, acute care, community) Pediatric assignments require RN experience in pediatrics (clinical, acute care, community) For Michigan Complete Health: Licensed RN; licensed nurse practitioner, licensed physician's assistant. Valid driver's license required. LTSS Requirements: Valid driver's license and proof of car insurance.
Mar 14, 2019
Full time
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 Develop, assess and adjust, as necessary, the care plan and promote desired outcome 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 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 Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs 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 For LTSS - 30% travel to perform home visits to members For New Hampshire, Massachusetts, & Michigan Complete Health - home visits required Qualifications: 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. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's RN license. For New Hampshire and Massachusetts: Valid driver's license For Arizona Complete Health - Complete Care Plan: Obstetrics (OB) assignments requires RN experience in OB (clinical, acute care, community) Pediatric assignments require RN experience in pediatrics (clinical, acute care, community) For Michigan Complete Health: Licensed RN; licensed nurse practitioner, licensed physician's assistant. Valid driver's license required. LTSS Requirements: Valid driver's license and proof of car insurance.
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 Develop, assess and adjust, as necessary, the care plan and promote desired outcome 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 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 Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs 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 For LTSS - 30% travel to perform home visits to members For New Hampshire, Massachusetts, & Michigan Complete Health - home visits required Qualifications: 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. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's RN license. For New Hampshire and Massachusetts: Valid driver's license For Arizona Complete Health - Complete Care Plan: Obstetrics (OB) assignments requires RN experience in OB (clinical, acute care, community) Pediatric assignments require RN experience in pediatrics (clinical, acute care, community) For Michigan Complete Health: Licensed RN; licensed nurse practitioner, licensed physician's assistant. Valid driver's license required. LTSS Requirements: Valid driver's license and proof of car insurance.
Mar 14, 2019
Full time
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 Develop, assess and adjust, as necessary, the care plan and promote desired outcome 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 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 Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs 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 For LTSS - 30% travel to perform home visits to members For New Hampshire, Massachusetts, & Michigan Complete Health - home visits required Qualifications: 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. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's RN license. For New Hampshire and Massachusetts: Valid driver's license For Arizona Complete Health - Complete Care Plan: Obstetrics (OB) assignments requires RN experience in OB (clinical, acute care, community) Pediatric assignments require RN experience in pediatrics (clinical, acute care, community) For Michigan Complete Health: Licensed RN; licensed nurse practitioner, licensed physician's assistant. Valid driver's license required. LTSS Requirements: Valid driver's license and proof of car insurance.
Description: Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems Qualifications: Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current State LPN/LVN or 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.
Mar 14, 2019
Full time
Description: Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems Qualifications: Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current State LPN/LVN or 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.
Description: Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.· Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations· Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings· Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care· Educate providers on utilization and medical management processes· Provide clinical knowledge and act as a clinical resource to non-clinical team staff· Enter and maintain pertinent clinical information in various medical management systems Qualifications: Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current State LPN/LVN or 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.
Mar 13, 2019
Full time
Description: Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.· Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations· Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings· Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care· Educate providers on utilization and medical management processes· Provide clinical knowledge and act as a clinical resource to non-clinical team staff· Enter and maintain pertinent clinical information in various medical management systems Qualifications: Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current State LPN/LVN or 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.
Description: Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems Qualifications: Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current State LPN/LVN or 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.
Mar 12, 2019
Full time
Description: Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems Qualifications: Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current State LPN/LVN or 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.
Description: Position Purpose: Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care Conduct discharge planning Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems For New Hampshire and Massachusetts - home visits required Qualifications: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Acute care experience preferred Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's LPN/LVN or 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.
Mar 12, 2019
Full time
Description: Position Purpose: Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care Conduct discharge planning Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems For New Hampshire and Massachusetts - home visits required Qualifications: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews. Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Acute care experience preferred Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's LPN/LVN or 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.
Description: Position Purpose: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment, and care coordination. Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development Monitor delivery of services and follow-up with members, caregivers, or providers through in person visits and telephonic contact Authorize and coordinate referral for services Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care Assist in coordinating the development of informal or voluntary services to integrate into the member care plan Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services Assist member with filing and resolving complaints and appeals Direct care to participating network providers Participate in care management committees and work on special projects related to care management as needed Qualifications: Education/Experience: Bachelor's degree or Registered Nurse and 3+ years of care management experience, Licensed Practical Nurse and 5+ years of care management experience, or 7+ years of care management experience. Home health, discharge planning, or long term care experience preferred. Licenses/Certifications: Valid driver's license. LPN or RN preferred. 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.
Mar 12, 2019
Full time
Description: Position Purpose: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment, and care coordination. Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development Monitor delivery of services and follow-up with members, caregivers, or providers through in person visits and telephonic contact Authorize and coordinate referral for services Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care Assist in coordinating the development of informal or voluntary services to integrate into the member care plan Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services Assist member with filing and resolving complaints and appeals Direct care to participating network providers Participate in care management committees and work on special projects related to care management as needed Qualifications: Education/Experience: Bachelor's degree or Registered Nurse and 3+ years of care management experience, Licensed Practical Nurse and 5+ years of care management experience, or 7+ years of care management experience. Home health, discharge planning, or long term care experience preferred. Licenses/Certifications: Valid driver's license. LPN or RN preferred. 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.
Description: Position Purpose: Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility. Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census. Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Screen members by priority for case management (CM) assessment. Perform transition of care duties to include but not limited to, contact the member's attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs. Coordinate services with community based organizations. Attend marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material. Data enter assessments and authorizations into the system.
Mar 12, 2019
Full time
Description: Position Purpose: Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care. Initiate authorization requests for output or input services in keeping with the prior authorization list. Research claims inquiry specific to the department and responsibility. Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results. Assess and monitor inpatient census. Screen for eligibility and benefits. Identify members without a PCP and refer to Member Services. Screen members by priority for case management (CM) assessment. Perform transition of care duties to include but not limited to, contact the member's attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs. Coordinate services with community based organizations. Attend marketing and outreach meetings as directed to represent the plan. Produces and mails routine CM letters and program educational material. Data enter assessments and authorizations into the system.
Description: Position Purpose: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment, and care coordination. Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development Monitor delivery of services and follow-up with members, caregivers, or providers through in person visits and telephonic contact Authorize and coordinate referral for services Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care Assist in coordinating the development of informal or voluntary services to integrate into the member care plan Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services Assist member with filing and resolving complaints and appeals Direct care to participating network providers Participate in care management committees and work on special projects related to care management as needed Qualifications: Education/Experience: Bachelor's degree or Registered Nurse and 3+ years of care management experience, Licensed Practical Nurse and 5+ years of care management experience, or 7+ years of care management experience. Home health, discharge planning, or long term care experience preferred. Licenses/Certifications: Valid driver's license. LPN or RN preferred. 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.
Mar 12, 2019
Full time
Description: Position Purpose: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment, and care coordination. Complete assessments with members, caregivers, or providers to obtain information regarding client status, support system, and need for services for care plan development Monitor delivery of services and follow-up with members, caregivers, or providers through in person visits and telephonic contact Authorize and coordinate referral for services Ensure provider services are delivered without gaps and identify functional deficiencies in plans of care Assist in coordinating the development of informal or voluntary services to integrate into the member care plan Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services Assist member with filing and resolving complaints and appeals Direct care to participating network providers Participate in care management committees and work on special projects related to care management as needed Qualifications: Education/Experience: Bachelor's degree or Registered Nurse and 3+ years of care management experience, Licensed Practical Nurse and 5+ years of care management experience, or 7+ years of care management experience. Home health, discharge planning, or long term care experience preferred. Licenses/Certifications: Valid driver's license. LPN or RN preferred. 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.
Description: Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems Qualifications: Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current State LPN/LVN or 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.
Feb 28, 2019
Full time
Description: Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care Educate providers on utilization and medical management processes Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems Qualifications: Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current State LPN/LVN or 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.
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 Develop, assess and adjust, as necessary, the care plan and promote desired outcome 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 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 Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs 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 For LTSS - 30% travel to perform home visits to members For New Hampshire, Massachusetts, & Michigan Complete Health - home visits required Qualifications: 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. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's RN license. For New Hampshire and Massachusetts: Valid driver's license For Arizona Complete Health - Complete Care Plan: Obstetrics (OB) assignments requires RN experience in OB (clinical, acute care, community) Pediatric assignments require RN experience in pediatrics (clinical, acute care, community) For Michigan Complete Health: Licensed RN; licensed nurse practitioner, licensed physician's assistant. Valid driver's license required. LTSS Requirements: Valid driver's license and proof of car insurance.
Feb 28, 2019
Full time
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 Develop, assess and adjust, as necessary, the care plan and promote desired outcome 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 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 Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs 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 For LTSS - 30% travel to perform home visits to members For New Hampshire, Massachusetts, & Michigan Complete Health - home visits required Qualifications: 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. Knowledge of healthcare and managed care preferred. Licenses/Certifications: Current state's RN license. For New Hampshire and Massachusetts: Valid driver's license For Arizona Complete Health - Complete Care Plan: Obstetrics (OB) assignments requires RN experience in OB (clinical, acute care, community) Pediatric assignments require RN experience in pediatrics (clinical, acute care, community) For Michigan Complete Health: Licensed RN; licensed nurse practitioner, licensed physician's assistant. Valid driver's license required. LTSS Requirements: Valid driver's license and proof of car insurance.
