full time healthcare management

Job Details

RN - Pediatric Case Manager - 1232980 Description 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


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. Professional fluency in Spanish and English is strongly preferred.

Licenses/Certifications: Current state's RN license.

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

  • Pediatrics - Birth to 21
  • Indian River County (Vero Beach), St Lucie County (Port St Lucie, Fort Pierce), Martin County (Stuart), or Okeechobee County, FL
  • Field/Local travel typically within county or at max within 60 miles. Caseload based on residence.
  • Work-from-home case management role with indefinitely suspended home visits due to COVID-19.
  • Travel will be 50-75% (Once we return again to member home visits)
  • Must reside in or be willing to relocate to the above mentioned area of Florida.

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.

Job: Clinical & Nursing Primary Location: USA-Florida-Port St. Lucie Other Locations: USA-Florida-Fort Pierce, USA-Florida-Stuart, USA-Florida-Okeechobee, USA-Florida-Vero Beach, USA-Florida-West Palm Beach Organization: Sunshine State Health Plan Schedule: Full-time

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