Sunshine Health
Overview
Pediatric Care Manager (RN)
role at
Sunshine Health
(Centene). Role details include remote/field-based work with local travel required for member visits up to 75% of the time. Candidates should reside in Palm Beach County, FL and hold licensure in the State of Florida. Responsibilities
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 member needs, barriers to accessing appropriate care, social determinants of health needs, focusing on member-identified priorities and recommending and/or facilitating the care plan for the best outcome. Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and community resources to address unmet needs. Identifies problems/barriers to care and provides appropriate care management interventions. Coordinates between the member and/or family/caregivers and the care provider team to ensure member-centered care and services. Provides ongoing follow up and monitoring of member status, changes in condition, and progress toward care plan goals; revises care plans as necessary to meet goals and unmet needs in collaboration with member, caregivers, and providers. Provides resource support to members and care managers for local resources (e.g., employment, housing, independent living, etc.) as appropriate. Facilitates care management and collaborates with appropriate providers or specialists to ensure timely access to needed care or services. May perform telephonic, digital, home, 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, instructions, referrals, and benefits. Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner. Other duties as assigned by the people leader to meet business needs. 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. Requirements / Licensure
RN licensure required Two (2) years minimum of related professional pediatric care experience Must reside in Palm Beach County, FL Bilingual Spanish-speaking candidates highly preferred 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 travel. Position Details
Pay Range: $55,100.00 - $99,000.00 per year Seniority level: Not Applicable Employment type: Full-time Job function: Health Care Provider Industries: Hospitals and Health Care and Insurance 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 schedules. Actual pay will be adjusted based on skills, experience, education, and other factors. Total compensation may include additional incentives and benefits may be subject to program eligibility. Equal opportunity employer statement and diversity notice as applicable per policy.
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Pediatric Care Manager (RN)
role at
Sunshine Health
(Centene). Role details include remote/field-based work with local travel required for member visits up to 75% of the time. Candidates should reside in Palm Beach County, FL and hold licensure in the State of Florida. Responsibilities
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 member needs, barriers to accessing appropriate care, social determinants of health needs, focusing on member-identified priorities and recommending and/or facilitating the care plan for the best outcome. Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and community resources to address unmet needs. Identifies problems/barriers to care and provides appropriate care management interventions. Coordinates between the member and/or family/caregivers and the care provider team to ensure member-centered care and services. Provides ongoing follow up and monitoring of member status, changes in condition, and progress toward care plan goals; revises care plans as necessary to meet goals and unmet needs in collaboration with member, caregivers, and providers. Provides resource support to members and care managers for local resources (e.g., employment, housing, independent living, etc.) as appropriate. Facilitates care management and collaborates with appropriate providers or specialists to ensure timely access to needed care or services. May perform telephonic, digital, home, 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, instructions, referrals, and benefits. Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner. Other duties as assigned by the people leader to meet business needs. 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. Requirements / Licensure
RN licensure required Two (2) years minimum of related professional pediatric care experience Must reside in Palm Beach County, FL Bilingual Spanish-speaking candidates highly preferred 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 travel. Position Details
Pay Range: $55,100.00 - $99,000.00 per year Seniority level: Not Applicable Employment type: Full-time Job function: Health Care Provider Industries: Hospitals and Health Care and Insurance 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 schedules. Actual pay will be adjusted based on skills, experience, education, and other factors. Total compensation may include additional incentives and benefits may be subject to program eligibility. Equal opportunity employer statement and diversity notice as applicable per policy.
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