Case Manager II - (RV11649)

Centene Corporation provides multi-line managed care programs and related services to individuals receiving benefits in Medicaid, including Supplemental Security Income (SSI) and the State Children's Health Insurance (SCHIP). Centene operates health plans in seven states. In addition, the Centene contracts with other healthcare organizations to provide specialty services including behavioral health, disease management, nurse triage and treatment compliance.

POSITION PURPOSE: Perform collaborative duties to assess, plan, coordinate and forecast potential financial exposure throughout the continuum of care for select members at high risk in order to promote quality cost-effective outcomes.

POSITION QUALIFICATION REQUIREMENTS:
Knowledge/Experience: Equivalent to nursing education, master's degree preferred plus 3 - 5 years recent nursing experience in an acute care setting and/or related specialty area. 1 - 3 years community health experience and/or work in an HMO or managed care environment.

Skills/ Competencies: Thorough knowledge of a specialized or technical field such as clinical nursing knowledge in obstetrics, prenatal services, asthma, diabetes or other speciality area involving thorough skills knowledge plus the application of basic theory. Ability to use computer skills for the management of medical information and reporting; good communication skills; pleasant, professional interpersonal skills; problem-solving orientation and skills; good analytical and mathematical skills, strong team player; self-starter, initiate assignments with minimal supervision. Second language proficiency desired.

Licenses/Certifications: Current state nursing license and drivers license. Case Management (CCM) Certification preferred

CRITICAL JOB ELEMENTS: Normal office work environment. Dexterity of hands and fingers and little physical effort. Normal mental effort, including timeliness of decision making, memory, and analytical thinking. Excellent verbal and non-verbal communications skills. Ability to hear and speak.

PRINCIPAL FUNCTIONS & ACCOUNTABILITIES:
Significant Duties: Conduct screening and risk assessment of identified members and coordinate with their physicians to facilitate individual plan of care to meet clients' needs.Assess and adjust as necessary the care plan to ensure compliance and promote desired outcome.Coordinate services between Primary Care Physician (PCP) specialist, and other medical and non-medical providers as necessary to meet the complete medical socio-economic needs of clients.Provide patient education regarding the clinical condition and basic health care needs at age specific levels to foster client understanding and compliance with care.Facilitate client/physician communication regarding basic health issues.Identify related risk management quality concerns and report these scenarios to appropriate resourcesContinue to review, develop and refine case/disease management programs in conjunction with the Medical Director and generally accepted standards as applicable in the community
Customer Service: Respond to phone calls from providers, clients and/or internal customers and resolve issues related to benefits, services, references to outside agencies, etc.Serve as a resource to internal and external customers and clients regarding medical and prenatal issues.
Reports: Collect and report quantifiable, quality of care and/or quality of life improvement as measured against goals of the care plan.Compile necessary statistics for monthly and quarterly reporting or active referrals, contacts, prenatal visits and prenatal outcomes.
Methods and Procedures: Participate in the development of policies and procedures to provide standards for medical review.
Attendance: Punctuality and regular attendance required including working extra hours.

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