RN, Senior LTSS Service Care Manager

Centene Corporation • San Juan, TX

8d • $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, promoting quality and cost-effective care. Develops personalized care plans or service plans for long-term care members, addresses issues, and educates members and their families or caregivers about available services and benefit options to help them receive appropriate, high-quality care.

This hybrid position includes home visits with members and remote work from home. The service delivery area includes Hidalgo County, Texas, and surrounding areas. Travel for member visits is required, and mileage reimbursement is provided for member assessment visits. The schedule is Monday through Friday, 8:00 AM–5:00 PM CST, with no on-call duties, evenings, weekends, or holidays.

The role requires graduation from an accredited school of nursing and 4–6 years of related clinical nursing and/or case management and care coordination experience. A Bachelor of Nursing degree is preferred. An RN state or compact-state license, or current state nurse licensure as an NP, is required. For Superior Health Plan, Resource Utilization Group (RUG) certification must be obtained within 90 days of hire.

The pay range is $36.21–$65.09 per hour. Centene offers a comprehensive benefits package, including competitive pay, health insurance, 401(k) and stock purchase plans, tuition reimbursement, paid time off and holidays, and flexible work arrangements. Actual pay may vary based on skills, experience, education, and other job-related factors; total compensation may include incentives. Benefits may be subject to program eligibility.

Requirements

• Graduate from an accredited school of nursing.
• 4–6 years of related clinical nursing and/or case management and care coordination experience.
• Experience in RN care coordination or case management with adult members (age 21 or older) in Behavioral Health, Home Health, Long-Term Care, Managed Care, Nursing Rehabilitation, or SNF.
• RN state licensure and/or compact-state licensure, or current state nurse licensure as an NP.
• For Superior Health Plan, obtain Resource Utilization Group (RUG) certification within 90 days of hire.
• Travel for member visits is required.

Nice To Haves

• Bachelor of Nursing degree preferred.

Responsibilities

• Evaluate service needs for the most complex or high-risk/high-acuity members and recommend plans for the best outcomes.
• Develop and continually assess long-term care plans or service plans, collaborating with the care management team to identify providers, specialists, and community resources.
• Coordinate between members and their families or caregivers and care provider teams to support adequate, appropriate, person-centered care or 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, as applicable.
• Review member data to identify trends and improve operating performance and quality of care in accordance with state and federal regulations.
• Review referral information and intake assessments to develop appropriate care plans or service plans.
• Collaborate with healthcare providers to facilitate member services or treatments and revise care plans when needed.
• Collect, document, and maintain member information and care management activities in accordance with current state, federal, and clinical guidelines.
• Provide or facilitate education for long-term care members and their families or caregivers about disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits.
• Act as liaison and member advocate between members or families, physicians, and facilities or agencies.
• Educate members about and coordinate community resources; coordinate service authorizations for services based on assessments and plans, such as meals, employment, housing, foster care, transportation, and activities of daily living.
• Perform home or other site visits, potentially monthly or more often, to assess member needs and collaborate with resources as required.
• Partner with leadership to improve quality of care and service delivery for long-term care members in a cost-effective manner.
• May precept clinical new hires by developing core skills, coaching, facilitating growth, and supporting onboarding.
• May guide and support clinical new hires or preceptees in navigating a managed care organization, including coaching and shadowing to connect classroom training with field practice.
• May support new hires or preceptees during onboarding, complete competency checkpoints, and assess 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.
• Travel for member visits.

Benefits

• Competitive pay
• Health insurance
• 401(k) plan
• Stock purchase plan
• Tuition reimbursement
• Paid time off
• Paid holidays
• Flexible approach to work, including remote, hybrid, field, or office work schedules
• Mileage reimbursement for member assessment visits

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree