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RN Care Manager I, Pediatrics, Bonus Eligible

Company: Sunshine State Health Plan
Location: Miami
Posted on: January 15, 2022

Job Description:

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility
This position is bonus eligible!
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
    Additional Details:

    • Department: Children's Medical Services CMS - (Enhanced Care Coordination / Med Fragile Team)

    • Caseload: Pediatrics - Newborn to 21-year olds receiving private duty nursing services.

    • Caseload based on residence.

    • Territory: Miami-Dade County (Hialeah, Miami Gardens, Miami, Palmetto Bay area).

    • Work-from-home case management role with temporarily suspended home visits due to COVID-19.

    • Field/Local travel typically within county.

    • Must reside in or be willing to relocate to the above mentioned area of Florida.

    • Travel will be 30% once we resume member home visits.
      Our Comprehensive Benefits Package:

      • Flexible work solutions including remote options, hybrid work schedules and dress flexibility

      • Competitive pay

      • Paid Time Off including paid holidays

      • Health insurance coverage for you and dependents

      • 401(k) and stock purchase plans

      • Tuition reimbursement and best-in-class training and development
        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.

        LTSS Requirements:

        Valid driver's license and proof of car insurance.

        For Sunshine Health (FL) Only: Employees supporting Florida's Children's Medical Services (CMS) must have a minimum of two years of pediatric experience.

        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.

Keywords: Sunshine State Health Plan, Miami , RN Care Manager I, Pediatrics, Bonus Eligible, Executive , Miami, Florida

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