Senior LTSS Service Care Manager RN

Centene Corporation

106d • $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 position requiring field visits and work from home, specifically serving the Dallas, Collin, Hunt, Rockwall, Kaufman, and Ellis Navarro counties. The position involves performing 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 to promote quality, cost-effective care. You will develop personalized care plans for long-term care members, address issues, and educate members and their families/caregivers on available services and benefit options to ensure appropriate high-quality care.

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 or NP - Nurse Practitioner - Current State's Nurse Licensure required.
• Resource Utilization Group (RUG) certification must be obtained within 90 days of hire.

Responsibilities

• 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 to address member's needs.
• 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; collaborates with member, caregivers, and appropriate providers to revise or update care plan/service plan as necessary.
• 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, as applicable.
• 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, as required.
• Partners with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner.
• May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process.
• Engages in a collaborative and ongoing process with People Leaders and cross-functional teams to measure and monitor readiness.

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

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees