Lead Care Manager, RN

Centene Corporation

Lead RN care manager overseeing complex-member care plans and quality outcomes for Centene, which connects people to healthcare. Providing remote call-center guidance, provider collaboration, and regulatory-compliant care management.

Posted 9/4/2026full-timeRemote • Florida • 🇺🇸 United StatesSenior💰 $87,000 - $161,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in care management and personalized care plans, with a strong focus on compliance with corporate, state, and NCQA standards. Proven ability to collaborate with healthcare providers and community resources to address member needs and improve care quality.

Highest-signal resume keywords

Registered Nurse - RN LicensureCare ManagementTelephonic OutreachCompliance MonitoringMember Data Analysis

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care PlansService PlansHealthcare BenefitsHealth Risk IdentificationDocumentation of Care Management Activities

Soft Skills

CollaborationLeadershipTraining and Education

Certifications & Qualifications

State LicensureCompact State Licensure

Industry Keywords

NCQA StandardsThird-Party PayerSpecialty PharmacyCall Center Experience

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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