Job Overview
Position Purpose:
The Care Manager I is responsible for providing care management services to beneficiaries with planned admissions to acute care hospitals, or to those transitioning from case management or disease management programs. Systematically identifies and addresses fragmented care for patients with acute, real-time needs and tailors interventions and services to fill gaps and produce optimal clinical outcomes cost-effectively.
- Pre-Admission Counseling
- Contacts patients with upcoming hospital admissions and discusses expectations.
- Assesses patient’s condition to understand illness or injury and evaluate ability to follow treatment plan.
- Advises patients of probable length of stay and helps anticipate and arrange for services at discharge.
- Admission Care
- Works with physicians and hospitals to enforce treatment plans and orders.
- Ensures patient receives specialty care and tests as ordered.
- Contacts medical team members to discuss patient’s course of progress and needs.
- Arranges for and coordinates health care team services, avoiding duplication and conserving benefit dollars.
- Evaluates need for and authorizes equipment, supplies, services.
- Identifies problems and acts to anticipate and avoid complications. Instructs patient and family in proper care and refers patient back to physician or other health care team members as needed.
- Identifies plateaus, improvements, regressions and depressions, and counsels accordingly.
- Coordination of Care
- Conducts hospital visits.
- Confers with physician to clarify diagnosis, prognosis, therapies, daily living activities, and to share information.
- Authorizes recommended modalities of treatment. Investigates and suggests alternatives appropriately.
- Documents case summary in Transitional Care Plan and shares appropriately with beneficiaries and providers.
- Facilitates beneficiary transfers among regions and collaborates with military liaison to minimize disruption care or services.
- Coordinates basic benefit. Identifies and submits modifications, requests for exceptions or special programs as warranted.
- Coordination of Financial Services
- Assesses patient’s benefit plan coverage and limitations.
- Negotiates cost-effective rates for provider services by contacting multiple providers and comparing specialty item costs, researching and identifying required equipment, and pursuing contracts accordingly.
- Suggests medically appropriate alternatives that accomplish treatment plan goals more cost effectively.
- Post Discharge Follow-up
- Contacts patients within 48 hours of discharge to ensure sufficient support for full recovery.
- Ensures proper receipt of equipment, home health and other services.
- Assesses compliance with medications and follow-up appointments.
Assists patient in coordinating transportation and other basic needs, and in navigating the health care system effectively.
Education/Experience:
Graduate of Nursing program, BSN Degree preferred, or Graduate in Clinical Psychology or Clinical Social Work
License/Certification:
Must have and maintain current, valid and unrestricted Registered Nurse, Clinical Psychologist, or Licensed Clinical Social Worker license . State Drivers License
This position will be supporting a Federal government contract, therefore it requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security.
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.
