Senior LTSS Service Care Manager RN

Centene • Farmers Branch, TX

87d • $35 - $63 • Remote

About The Position

As a Senior LTSS Service Care Manager RN, you will perform 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. Your role will involve developing personalized care plans for long-term care members, addressing issues, and educating members and their families on available services and benefit options. You will evaluate the service needs of high-risk members, recommend plans for optimal outcomes, and continuously assess ongoing care plans while collaborating with the care management team. Additionally, you will monitor member status, review data to identify trends, and act as a liaison between members, families, and healthcare providers. This position requires home visits and coordination of various services based on assessments.

Requirements

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

Nice To Haves

• Bachelor's degree in Nursing preferred.

Responsibilities

• Perform care management duties to assess and coordinate medical and supporting services.
• Develop personalized care plans for long-term care members.
• Evaluate service needs of complex or high-risk members.
• Collaborate with care management team to identify necessary providers and resources.
• Monitor care plans and member status, revising as necessary.
• Review member data to improve operating performance and quality care.
• Collaborate with healthcare providers to facilitate member services.
• Document and maintain member information for compliance.
• Educate members and families on disease processes and care options.
• Act as a liaison and advocate for members.
• Coordinate service authorization for various services.
• Perform home and site visits to assess member needs.
• Partner with leadership to enhance quality of care.
• Precept clinical new hires and provide guidance.
• Engage in collaborative processes with cross-functional teams.
• Perform other duties as assigned.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree