Healthcare Specialist

6 days ago


Seattle, Washington, United States Centene Full time
About Centene

Centene is a diversified, national organization that is transforming the health of its communities, one person at a time. With 28 million members, the company offers a fresh perspective on workplace flexibility and provides access to competitive benefits.

Salary Information

The estimated salary for this position ranges from $54,000 to $97,100 per year. Total compensation may also include additional forms of incentives.

Job Description

This role involves developing, assessing, and facilitating complex care management activities for primarily physical needs members. The primary goal is to provide high-quality, cost-effective healthcare outcomes, including personalized care plans and education for members and their families.

Key Responsibilities
  1. Evaluate member needs, barriers to accessing appropriate care, social determinants of health needs, focusing on what the member identifies as priority, and recommend and/or facilitate a plan for the best outcome.
  2. Develop ongoing care plans/service plans and collaborate with providers to identify providers, specialists, and/or community resources to address member's unmet needs.
  3. Identify problems/barriers to care and provide appropriate care management interventions.
  4. Coordinate 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.
  5. Provide 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.
  6. Provide 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.
  7. Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services.
  8. May perform telephonic, digital, home, and/or other site outreach to assess member needs and collaborate with resources.
  9. Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators.
  10. 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.
  11. Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner.
Requirements

To be successful in this role, you will require a degree from an accredited school of nursing or a Bachelor's degree in Nursing and 2-4 years of related experience. You must also hold an RN - Registered Nurse - State Licensure and/or Compact State Licensure, as well as an active CA RN License.



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