RN, Senior LTSS Service Care Manager

Centene Management Company•Desoto, TX

15d•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 long-term care and service plans, addresses member issues, and educates members and their families or caregivers about available services and benefits to support appropriate, high-quality, cost-effective care. This is a hybrid RN Care Manager role supporting Duals AIP adult members with complex medical needs. The position includes home visits for clinical health assessments and offers autonomy to coordinate long-term services and supports and self-schedule member visits from a home office. The service delivery area is South Dallas, Texas, including the listed ZIP codes. Mileage for member visits is reimbursed. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. CST, with no on-call duties, evenings, weekends, or holidays. The role may include precepting clinical new hires, coaching and supporting their onboarding and field readiness, and collaborating with People Leaders and cross-functional teams to monitor readiness. The employee also performs other duties as assigned and complies with applicable policies and standards.

Requirements

Graduate from an accredited school of nursing.
Four to six years of related clinical nursing experience.
Strong clinical documentation, problem-solving, communication, attention to detail, and organization/time-management skills.
Ability to work effectively under short turnaround times and deadlines.
Ability to adapt to changing business needs with openness, flexibility, and professionalism.
Registered Nurse state licensure and/or compact state licensure, or current state Nurse Practitioner licensure.
For Superior, Resource Utilization Group (RUG) certification is required within 90 days of hire.

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred.
Seven or more years of clinical RN case management or care coordination experience with adult members requiring 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 to achieve the best outcomes.
Develop and continually assess long-term care and service plans; collaborate 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 for complications, clinical symptoms, and other status changes, including assessing potential 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 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 liaison and member advocate among members and families, physicians, and facilities or agencies.
Educate members about and coordinate community resources.
Coordinate service authorization for members and care managers for services such as meals, employment, housing, foster care, transportation, and activities of daily living, based on assessments and plans.
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 and facilitating growth, and guiding onboarding to improve readiness.
May support clinical new hires and 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.
Collaborate with People Leaders and cross-functional teams to measure and monitor readiness.
Perform other duties as assigned and comply with all policies and standards.