RN, Senior LTSS Service Care Manager

Centene Corporation • Red Oak, TX

15d • $36 - $65 • Hybrid

About The Position

Performs care management duties to assess and coordinate medical and supporting services across the continuum of care for complex or high-acuity populations with primary medical or physical health needs. The role promotes quality, cost-effective care and develops personalized long-term care and service plans. It addresses member needs and educates members and their families or caregivers about services and benefit options.

This hybrid RN Care Manager position supports adult Duals AIP members with complex medical needs. It includes home visits to conduct clinical health assessments and provides flexibility and autonomy to coordinate long-term services and supports (LTSS), including self-scheduling member visits from a home office. The service area includes Dallas, Texas, and surrounding communities. Mileage is reimbursed.

The schedule is Monday through Friday, 8:00 AM–5:00 PM CST, with no on-call duties, evenings, weekends, or holidays. The role may also support and precept clinical new hires, helping them build skills, complete competency checkpoints, and become ready for service coordination work.

Requirements

• Graduate of an accredited school of nursing.
• 4–6 years of related clinical nursing experience.
• RN state licensure and/or compact state licensure, or current state nurse practitioner licensure.
• For Superior, Resource Utilization Group (RUG) certification must be obtained within 90 days of hire.
• Strong clinical documentation, problem-solving, communication, attention to detail, and organization/time-management skills.
• Ability to work well under quick turnaround times and deadlines.
• Ability to adapt to changing business needs with openness, flexibility, and professionalism.

Nice To Haves

• Bachelor of Science in Nursing (BSN).
• 7+ years of clinical RN case management or care coordination experience with adult members needing transitions of care from inpatient settings to home care, assisted living, home health, hospice, long-term care, or skilled nursing facilities.

Responsibilities

• Evaluate service needs of complex or high-risk/high-acuity members and recommend plans to achieve the best outcomes.
• Develop and continually assess long-term care plans and service plans, collaborating with the care management team to identify providers, specialists, and community resources.
• Coordinate between members, families or caregivers, and care providers to ensure adequate, appropriate, person-centered care and services.
• Monitor care plans, member status, changes in condition, and progress toward goals; collaborate with members, caregivers, and providers to revise plans as needed.
• Monitor members for complications, clinical symptoms, and other status changes, including needs for a higher level of care or waiver eligibility when applicable.
• Review member data to identify trends and improve operating performance and quality of care in accordance with state and federal regulations.
• Review referrals and intake assessments to develop appropriate care plans and service plans.
• Collaborate with healthcare providers to facilitate services or treatments and determine revised care plans when needed.
• Collect, document, and maintain member information and care management activities in compliance with current state, federal, and clinical guidelines.
• Provide or facilitate education for members and families or caregivers on disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits.
• Act as a liaison and member advocate among members and families, physicians, and facilities or agencies.
• Educate members about community resources and coordinate resources and service authorizations based on assessments and plans, including meals, employment, housing, foster care, transportation, and activities of daily living.
• Perform home or other site visits as required to assess member needs and collaborate with resources.
• Partner with the leadership team to improve quality of care and service delivery for long-term care members in a cost-effective manner.
• May precept clinical new hires by coaching them, building core skills, facilitating growth, and guiding onboarding.
• May guide and support clinical new hires or preceptees in navigating a Managed Care Organization and provide coaching and shadowing to bridge classroom training and field practice.
• May assist new hires or preceptees throughout onboarding, including completing competency checkpoints and assessing readiness for service coordination.
• Collaborate with people leaders and cross-functional teams to measure and monitor readiness.
• Perform other duties as assigned.
• Comply with all policies and standards.

Benefits

• Competitive pay.
• Health insurance.
• 401(k) and stock purchase plans.
• Tuition reimbursement.
• Paid time off and holidays.
• Flexible approach to work, including remote, hybrid, field, or office schedules.
• Mileage reimbursement.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed