New 
Clinical - Care Manager (RN) - J01007
 Spectraforce Technologies | |
 United States, North Carolina, Raleigh | |
| 500 West Peace Street (Show on map) | |
 Apr 07, 2026 | |
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Job Profile Summary:
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, costeffective healthcare outcomes including personalized care plans and education for members and their families. EducationExperience: Requires a Degree from an Accredited School of Nursing or a Bachelors degree in Nursing and 2 4 years of related experience. LicenseCertification: RN Registered Nurse State Licensure andor Compact State Licensure required For YouthCare Illinois plan only: Bachelors Degree and IL RN licensure required. Must reside in IL For Sunshine Health FL Only: Employees supporting Floridas Childrens Medical Services CMS must have a minimum of two years of pediatric experience. May require up to 80 local travel required Responsibilities: Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends andor facilitates the plan for the best outcome Develops ongoing care plans service plans and collaborates with providers to identify providers, specialists, andor community resources to address members unmet needs Identifies problemsbarriers to care and provide appropriate care management interventions Coordinates as appropriate between the member andor familycaregivers and the care provider team to ensure members are receiving adequate and appropriate personcentered care or services Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan service plan goals collaborate with member, caregivers, and appropriate providers to revise or update care plan service plan as necessary to meet the members goals unmet needs Provides resource support to members and care managers for local resources for various services e.g., employment, housing, participant direction, independent living, justice, foster care based on service assessment and plans, as appropriate Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services May perform telephonic, digital, home andor other site outreach to assess member needs and collaborate with resources Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and thirdparty payer regulators Provides andor facilitates education to members and their familiescaregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a costeffective manner Other duties or responsibilities as assigned by people leader to meet business needs Performs other duties as assigned. Complies with all policies and standards. Release Comments: Please use the below link to begin submitting Candidates. https:prod.beeline.comcentene5052484b9fda47e198e69b4e9e4e32a1 This email has been generated to notify you of account activity that has occurred within the Beeline application. Please review the details above for necessary action on your part, or click on the link provided to login to the application to review the activity. Please do not reply to this email. If you need assistance, please contact application support at 1866Beeline or supportbeeline.com. | |