Senior LTSS Service Care Manager, RN
Centene Corporation
Salary
💰 $73,000 - $75,000 per year
Job Level
Mid-LevelSenior
About the role
- Partner with the injured worker, employer, and medical providers to create a case management strategy to facilitate medical recovery and a successful return to work through advocacy, communication and coordination of medical services
- Perform initial and ongoing clinical assessment via telephone calls to evaluate the injured worker's injury, medical treatment, psychosocial needs, cultural implications and support systems
- Effectively communicate and build relationships with the claims’ examiner, client, injured worker, attorney and supervisor
- Identify issues related to delayed recovery and/or return to work and problem solve with a creative thinking approach
- Negotiate treatment and disability duration with providers through use of medical and disability duration guidelines, adhering to quality
- Identify opportunities to expedite care for cost containment and timely medical recovery
- Provide recommendations for alternate clinical resources to support claim resolution
- Maintain client's privacy and confidentiality, promote client safety and advocacy; and adhere to ethical, legal, accreditation and regulatory standards
Requirements
- Current unrestricted RN license(s) in a state or territory of the United States required
- Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred
- Certification in case management, rehabilitation nursing or a related specialty is highly preferred
- Medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury
- Ability to perform initial and ongoing clinical assessment via telephone
- Strong communication and relationship-building skills with claims examiners, clients, injured workers, attorneys, and supervisors
- Ability to identify delayed recovery issues and problem solve creatively
- Knowledge of medical and disability duration guidelines and ability to negotiate with providers
- Maintain client privacy and confidentiality and adhere to ethical, legal, accreditation and regulatory standards
- Ability to work remotely and thrive in a collaborative environment
