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Case Manager II

Centene Corporation Type Full time Posted 6/27/2014
Salary - n/a - Starts - n/a -
MA - Massachusetts (All) - Waltham Referral - n/a -    

Case Manager II - 1001408

Description
Position Purpose: Perform collaborative duties to assess and coordinate member care. Forecast potential financial exposure throughout the continuum of care in order to promote quality, cost effective outcome.

  • Develop and implement comprehensive, cost-effective plans of care and conduct assessments/reassessments as needed or required
  • Educate members and families about services/requirement and ensures member involvement in plan of care
  • Authorize and coordinate referral for services and conducts assessments/reassessments
  • Ensure provider services are delivered without gaps Coordinates community based service not covered by Medicaid for dually eligible members
  • Monitor members care and condition, pharmacy utilization and prescription patterns
  • Participate in discharge planning and conducts post-discharge follow-up
  • Assist member with filing and resolution complaints and appeals

 
Qualifications
 
Education/Experience:
Acute
4+ years of combined clinical nursing and case management experience.

License/Certification: RN license.

Long Term Care
4+ years of combined clinical nursing and long term care, social work, or care coordination experience, preferably in a HMO setting.

License/Certification: Valid driver's license.

Job: Clinical & Nursing

Primary Location: USA-Massachusetts-Waltham

Organization: Health Plans

Schedule: Full-time