Client care manager job description

Our mission is clear. We bring to life a healing ministry through our compassionate care and exceptional service.

At Mercy, we believe in careers that match the unique gifts of unique individuals – careers that not only make the most of your skills and talents, but also your heart. Join us and discover why Modern Healthcare Magazine named us in its “Top 100 Places to Work.”

Overview:

The Care Manager facilitates transition of care planning with an interdisciplinary healthcare team to achieve quality outcomes, reduce costs and ensure patient safety.

Qualifications:

Education

- Graduate of an accredited School of Nursing

- Bachelor's Degree of Science in Nursing

Licensure

- Current License in the state of employment, Required

Experience

- 2-3 years acute care hospital setting, Required

- Care Management or Utilization Management experience, Preferred

Certification/Registration

- BLS (CPR) at hire date, Minimum Required, or within 90 days of hire

- Certification in Case Management, Preferred

Other Skills & Knowledge

- Strong verbal and written communication and facilitation skills, Minimum Required

- Strong assessment skills, time management skills, critical thinking skills, Minimum Required

- Advanced computer skills, Minimum Required

- Must have ability to interact effectively with a variety of people and situations at all levels of the organization, Minimum Required

- Knowledge of InterQual criteria, Preferred

We Offer Great Benefits:

Day-one comprehensive health, vision and dental coverage, PTO, tuition reimbursement and employer-matched retirement funds are just a few of the great benefits offered to eligible co-workers, including those working 48 hours or more per pay period!

We’re bringing to life a healing ministry through compassionate care.

At Mercy, our supportive community will be behind you every step of your day, especially the tough ones. You will have opportunities to pioneer new models of care and transform the health care experience through advanced technology and innovative procedures. We’re expanding to help our communities grow. Join us and be a part of it all.

What Makes You a Good Match for Mercy?

Compassion and professionalism go hand-in-hand with us. Having a positive outlook and a strong sense of advocacy is in perfect step with our mission and vision. We’re also collaborative and unafraid to do a little extra to deliver excellent care – that’s just part of our commitment. If that sounds like a good fit for you, we encourage you to apply.

Mercy has determined this is a safety-sensitive position. The ability to work in a constant state of alertness and in a safe manner is an essential function of this job.

The Consultant role is a senior level member of the Dispute & Support Operations (DSO) team. The individual contributor is responsible for supporting client training and education efforts directly related to dispute questions. This may include regulatory reviews, assisting with client or internal audits, as well as questions from internal partners. Successful execution of dispute related projects or changes, supporting new client onboarding post implementation, ongoing training for clients, help drive various projects impacting the dispute team, assisting sales in DSO initiatives, and the ongoing health and growth of the organizational footprint within the industry. Candidates should be passionate, detail-oriented, and client focused with extensive experience in addressing client concerns and applying independent judgment in resolving issues and making recommendations.
Essential Functions

Onboard new clients post implementation to ensure smooth transition to BAU

Act as a consultant to clients to improve service, partnership and potential revenue gains, help train on systems, processes and disputes as necessary

Communicate verbally or in written form directly with clients, vendors, and internal resources on a variety of topics

Development and maintenance of a training/consulting schedule for both value added services and paid for consulting with clearly defined lines and goals for each

Work closely with DSO leadership to provide ongoing fresh ideas and suggestions for better ways of supporting client needs and growing the business

Offer Subject Matter Expert level expertise for all dispute related questions from internal staff, clients, executive management and other entities

Ensure processing is consistent with all Service Descriptions and one-off processes are avoided

Have visionary expertise to see beyond day-to-day needs in order to plan for and accommodate future requirements

Communicate regularly to stakeholders on initiative milestones

Provide reporting as necessary

Maintain a high degree of knowledge on dispute processing across all product lines

Liaison between internal quality assurance department; assist with the SSAE external audit

Other requirements as assigned

Work off business hours as required to support the global team

This is a hybrid position. Hybrid employees can alternate time between both remote and office. Employees in hybrid roles are expected to work from the office two days a week, Tuesdays and Wednesdays with a general guidepost of being in the office 50% of the time based on business needs.

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options

Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes

Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
Provide patient and provider education

Facilitate member access to community based services

Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan

Actively participate in integrated team care management rounds

Identify related risk management quality concerns and report these scenarios to the appropriate resources

Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience

Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems

Direct care to participating network providers

Perform duties independently, demonstrating advanced understanding of complex care management principles

Participate in case management committees and work on special projects related to case management as needed
Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.

Licenses/Certifications: Current state’s RN license.

Texas Requirements:
Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing or case management experience in a clinical, acute care, managed care or community setting. 2+ years experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs. Other state specific requirements may apply.

Licenses/Certifications: Current state’s RN license.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.