Position Purpose: Develops, assesses, and coordinates complex discharge plans for high-risk members based upon needs assessment. Assists with the facilitation of a smooth transition from the acute care setting to the next level of care and educates members and their families/caregivers on discharge plan to ensure appropriate high-quality transitional care.
Key Details: This is a fully remote opportunity that requires an active Compact RN License. Prior Case Management and/or Discharge Planning experience working in a telephonic environment highly preferred.
Develops complex discharge plans based on level of care of members needs determined by needs assessment to ensure appropriate level of care
Interacts with providers, community agencies, and other utilization review staff to coordinate and ensure a safe, effective, and clinically appropriate transition plan for the member
Assists with managing member’s discharge plans to ensure a timely and smooth discharge between levels of care and facilities
Collects, documents, and maintains all discharge plans taken on member medical records in health management systems according to utilization management policies and guidelines
Assists with providing education to members and their families on discharge plan and utilization processes to ensure high quality appropriate care to members, as applicable
Provides feedback to leadership on opportunities to improve the discharge planning process for members to ensure high-quality transitional care
Coordinates and assists with completion of prior authorizations as they related to discharge planning, as applicable
Assists concurrent review team as needed
Performs other duties as assigned
Complies with all policies and standards
Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. 2+ years of acute care experience required.
Clinical knowledge of discharge planning competencies preferred.
Knowledge of Medicare and Medicaid regulations preferred.
Knowledge of utilization management processes preferred.
License/Certification:
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
Centene Corporation is a diversified, national healthcare organization serving 28 million members across the United States. The company operates multiple state health plans, including Fidelis, and focuses on transforming community health through managed care services. Centene provides comprehensive healthcare management services including medical necessity reviews, prior authorization processes, cost containment initiatives, and fraud, waste, and abuse prevention programs. The organization emphasizes quality care delivery and cost-effectiveness while maintaining regulatory compliance with Medicare, Medicaid, and state-specific healthcare requirements.
