Lead Care Navigator

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: Oversees and/or coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Reviews and provides expert knowledge to inform personalized care plans/service plans for members with higher level of care needs and provides guidance and/or support to the care management team.
• Oversees, reviews, and/or coordinates ongoing care plans/service plans and works with care management team to identify providers, specialist, and/or community resources needed for care
• Provides insight and guidance on developing care plans/service plans and triaging issues to appropriate healthcare providers for escalated care plans/service plans
• Provides guidance and expert knowledge as appropriate to team members to ensure quality control over work, and adherence to contract policies and procedures
• Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans
• May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate
• Provides subject matter expertise insights for escalated care plans/service plans based on prior experience to recommend enhanced member care within the care management plan
• Reviews member data to identify trends and improve operating performance and quality care and provides recommendations in accordance with state and federal regulations
• Partners and collaborates with healthcare partners regarding escalated cases as appropriate to facilitate member care to ensure member needs are met and determine a revised service plan/care plan for member if needed
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
• May perform on site visits to assess member’s needs and collaborate with providers or resources, as appropriate
• Provides training and education to care management team and providers to ensure members are receiving high quality care and information regarding treatment plan options, procedures, referrals, and healthcare benefits
• Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner
• Other duties or responsibilities as assigned by people leader to meet the member and/or business needs
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Requires Bachelor’s degree and 5 – 7 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

License/Certification:
• Current state’s clinical license preferred
Pay Range: $30.00 - $54.03 per hour

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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