Pediatric Senior Care Navigator at Sunshine State Health Plan

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

This position is remote with local travel required for member visits. Candidates should reside in Palm Beach County to be considered for the role. Bilingual Spanish speaking candidates strongly preferred.

For Sunshine Health (FL): Employees supporting Florida's Children’s Medical Services (CMS) must be a Florida licensed registered nurse with a minimum of two years of pediatric experience, Florida licensed practical nurse with a minimum of four years of pediatric experience, or a Master’s degree in social work with a minimum of one year of related professional pediatric care experience.

Position Purpose: Assesses, plans, implements, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.

• Develops or contributes to the development of ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care
• Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members in a timely manner
• May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate
• Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans
• Identifies problems/barriers for care coordination and appropriate care management interventions for members with higher level of care needs
• Reviews referrals information and intake assessments to develop or assist in the development of appropriate care plan/service plan for members with higher level of care needs
• Collaborates with healthcare partners as appropriate to facilitate member care to ensure member needs are met and determine if care plan/service plan revision is needed
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
• May perform on-site visits to assess member’s needs and collaborate with providers or resources, as appropriate
• May provide education to care managers and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits
• Serves as a Subject Matter Expert (SME) to support the care navigation team and/or serve as a preceptor for newly hired staff
• Other duties or responsibilities as assigned by people leader to meet the member and/or business needs
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Requires a Bachelor’s degree and 4 – 6 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure.

Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

License/Certification:

• Current state’s clinical license preferred

• For Sunshine Health (FL): Employees supporting Florida's Children’s Medical Services (CMS) must be a Florida licensed registered nurse with a minimum of two years of pediatric experience, Florida licensed practical nurse with a minimum of four years of pediatric experience, or a Master’s degree in social work with a minimum of one year of related professional pediatric care experience

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 work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act