RN Senior LTSS Service Care Manager

Centene Corporation • TX

101d • $35 - $63

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. This is a hybrid role: 50% remote and 50% travel to visit members in person within the service area. The service area includes performing in-person visits to members (primarily facility-based) in between Del Rio, Camp Wood, Uvalde, Cotulla, and Carrizo Springs, Texas. Must reside within the service area.

Requirements

• Graduate from an Accredited School of Nursing or a Bachelor's degree and 4–6 years of related experience.
• Bachelor's degree in Nursing preferred.
• RN - Registered Nurse - State Licensure and/or Compact State Licensure required.
• Resource Utilization Group (RUG) certification must be obtained within 90 days of hire.

Responsibilities

• Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs.
• Develops a personalized care plan/service plan for long-term care members, addresses issues, and educates members and their families/caregivers on services and benefit options available.
• Evaluates the service needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome.
• Develops and continuously assesses ongoing long-term care plans/service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed.
• Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services.
• Monitors care plans/service plans and/or member status, change in condition, and progress towards care plan/service plan goals.
• Monitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility.
• Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations.
• Reviews referrals information and intake assessments to develop appropriate care plans/service plans.
• Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed.
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines.
• Provides and/or facilitates education to long-term care members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits.
• Acts as liaison and member advocate between the member/family, physician, and facilities/agencies.
• Educates on and coordinates community resources.
• Provides coordination of service authorization to members and care managers for various services based on service assessment and plans.
• May perform home and/or other site visits to assess member needs and collaborate with resources.
• Partners with leadership team to improve and enhance quality of care and service delivery for long-term care members.
• May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth.
• Engages in a collaborative and ongoing process with People Leaders and cross-functional teams to measure and monitor readiness.
• Performs other duties as assigned.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field or office work schedules

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees