RN, Senior LTSS Service Care Manager

Centene Corporation•Lewisville, TX

1d•$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 and physical health needs. The role promotes quality, cost-effective care and develops personalized long-term care plans or service plans. It addresses member needs and educates members and their families or caregivers about available services and benefit options. This hybrid RN Care Manager position supports Duals AIP adult members with complex medical needs. It includes home visits for clinical health assessments and allows the care manager to coordinate long-term services and supports (LTSS) and self-schedule member visits from a home office. The service delivery area is South Dallas, Texas. Mileage for member visits is reimbursed. The schedule is Monday through Friday, 8:00 AM to 5:00 PM CST. The position has no on-call duties, evening, weekend, or holiday work. The role may also support the onboarding and development of clinical new hires and preceptees.

Requirements

Graduate of an accredited school of nursing.
4–6 years of related clinical nursing experience.
Current RN state licensure and/or compact state licensure, or current state nurse licensure as a Nurse Practitioner.
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 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) preferred.
7+ years of clinical RN case management or care coordination experience with adult members in assisted living, home health, hospice, long-term care, or skilled nursing facilities preferred.

Responsibilities

Evaluate service needs of complex or high-risk/high-acuity members and recommend plans to achieve the best outcomes.
Develop and continuously assess long-term care plans or service plans, collaborating with the care management team to identify needed 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 possible need 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 services or treatments and revise member 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 members and families or caregivers on disease processes, resolving care gaps, provider instructions, care options, referrals, and healthcare benefits.
Act as a liaison and member advocate among members or families, physicians, and facilities or agencies.
Educate members on and coordinate community resources and 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 as needed, potentially monthly or more frequently, to assess member needs and collaborate with resources.
Partner with leadership to improve the quality and cost-effectiveness of care and service delivery for long-term care members.
May precept clinical new hires by fostering core skills, coaching, 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 during onboarding, including completing competency checkpoints and ensuring readiness for service coordination.
Engage in an ongoing collaborative process with people leaders and cross-functional teams to measure and monitor readiness.
Perform other duties as assigned and comply with all policies and standards.