Behavioral Health, Maternity RN - Care Manager

Behavioral Health, Maternity RN - Care Manager page is loaded## Behavioral Health, Maternity RN - Care Manager locations:
Remote-ILtime type:
Full time posted on:
Posted Todayjob requisition :
1611401

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.
*
* NOTE:

This is a fully remote role with serving maternity and postnatal members with behavioral health conditions. Preference will be given to individuals who (1) possess an active Illinois registered nurse (RN) license, (2) have a combination of professional experience with high-risk maternity and behavioral health/substance use, as well as (3) virtual service coordination, case management, community advocacy. (4) Spanish language fluency is a plus.
**** Additional Details:  
• Line of Business:
Illinois Health Plan  
• Department: MED-Medical Management (Case Management)  
•

Schedule:

Monday through Friday, 8 AM to 5 PM Central  
• Caseload: behavioral health maternity members.

**** Position

Purpose:

** Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.
* Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome
* Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs
* Identifies problems/barriers to care and provide appropriate care management interventions
* Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
* Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs
* Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate
* Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services
* May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
* Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
* Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
* Provides feedback to leadership on opportunities 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 business needs
* Performs other duties as assigned.
* Complies with all policies and standards.
** Education/

Experience:

** Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of related experience.

** License/Certification:*
* * RN - Registered Nurse - State Licensure and/or Compact State Licensure required
* For Youth Care Illinois plan only:
Bachelor’s Degree and IL RN licensure required. Must reside in IL
* For Sunshine Health (FL) Only:
Employees supporting Florida's Children’s Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local…