RN, Senior LTSS Service Care Manager

Centene Management Company • Dallas, TX

14d • 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. 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 support appropriate, high-quality care.

This hybrid RN Care Manager position supports Duals AIP adult members with complex medical needs. The role includes home visits for clinical health assessments and the flexibility to coordinate LTSS needs and self-schedule member visits from a home office. The service area includes Dallas, Texas, and surrounding areas. 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 position may also support clinical new hires through precepting, coaching, onboarding, competency checks, and field-practice shadowing. Other duties may be assigned, and the role must comply with all policies and standards.

Requirements

• Graduate from an accredited school of nursing.
• 4–6 years of related clinical nursing experience.
• 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.
• RN state licensure and/or compact state licensure, or current state nurse licensure as a Nurse Practitioner.
• For Superior, obtain Resource Utilization Group (RUG) certification within 90 days of hire.

Nice To Haves

• Bachelor of Science in Nursing (BSN) degree preferred.
• 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 preferred.

Responsibilities

• Evaluate service needs of the most complex or high-risk/high-acuity members and recommend plans for 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 or their families/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.
• 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 compliance with state, federal, and clinical guidelines.
• Provide or facilitate education for members and their families/caregivers on disease processes, 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 about and coordinate community resources.
• Coordinate service authorizations for members and care managers for services based on assessments and plans, such as meals, employment, housing, foster care, transportation, and activities of daily living.
• Conduct 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 building core skills, coaching, facilitating growth, and guiding onboarding.
• May support clinical new hires or preceptees in navigating a Managed Care Organization and provide coaching and shadowing to connect classroom training with field practice.
• May assist new hires or preceptees during onboarding, complete competency checkpoints, and assess readiness for service coordination.
• Engage with People Leaders and cross-functional teams in an ongoing process to measure and monitor readiness.
• Perform other duties as assigned and comply with all policies and standards.

Benefits

• Competitive pay
• Health insurance
• 401K plan
• Stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field, or office work schedules
• Additional forms of incentives may be included in total compensation, subject to applicable factors and program eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior