Lead Care Manager, RN

🔥 18 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $87k - $161.3k / year

⏰ Full Time

🟠 Senior

👔 Manager

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Oversee care plans/service plans and care management activities for complex care members • Review and provide expert knowledge for personalized care plans/service plans • Collaborate with providers, specialists, and community resources to address unmet member needs • Guide care management team members and triage issues to appropriate healthcare providers • Monitor member status, outcomes, changes in condition, and revise care plans as needed • Work with senior management on escalated and complex care cases • Perform telephonic, digital, home and/or other site outreach to assess member needs • Review member data to identify health risks and care gaps • Monitor team policies and procedures for compliance with corporate, state, and NCQA standards • Partner with healthcare providers to facilitate treatment and determine revised care plans • Document member information and care management activities for regulatory compliance • Provide subject matter expertise, training, and education to care management teams and providers • Partner with leadership to improve cost-effective care and quality delivery • Perform other duties as assigned and comply with all policies and standards

🎯 Requirements

• Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing • 5–7 years of related experience • RN - Registered Nurse - State Licensure and/or Compact State Licensure required • Experience in a call center environment • Specialty pharmacy experience is a plus • Knowledge of care plans/service plans, care management, healthcare providers, specialists, community resources, and healthcare benefits • Knowledge of corporate, state, federal, third-party payer, and NCQA standards • Ability to perform telephonic, digital, home and/or other site outreach • Ability to collect, document, and maintain member information and care management activities

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity