Senior LTSS Service Care Manager RN - Pediatrics
About The Position
The Senior LTSS Service Care Manager RN performs care management for complex and high-acuity populations with primary medical and physical health needs. The role assesses and coordinates medical and supporting services across the continuum of care to promote quality, cost-effective outcomes. It develops personalized long-term care and service plans, addresses members’ needs, and educates members and their families or caregivers about services and benefit options. This hybrid role includes in-home assessments and may involve home or other site visits, such as monthly or more often, to assess member needs and collaborate with resources. The Care Manager coordinates with members, caregivers, providers, specialists, and community resources; monitors care plans and changes in members’ conditions; and revises plans as needed. The position also documents activities to meet applicable state, federal, and clinical guidelines, facilitates education and service authorization, and advocates for members. It may include precepting and coaching clinical new hires during onboarding.
Requirements
- Graduate from an accredited school of nursing or have a bachelor's degree and 4–6 years of related experience.
- Must be licensed in Texas.
- RN (Registered Nurse) state licensure and/or compact state licensure, or current state Nurse Practitioner licensure, is required.
- Resource Utilization Group (RUG) certification must be obtained within 90 days of hire.
Nice To Haves
- Bachelor’s degree in Nursing preferred.
Responsibilities
- Assess service needs for complex or high-risk/high-acuity members and recommend plans to achieve the best outcomes.
- Develop and continuously assess long-term care plans and service plans.
- Collaborate with the care management team to identify providers, specialists, and community resources needed to address members’ needs.
- Coordinate between members and their families or caregivers and care providers to help ensure appropriate, person-centered care and services.
- Monitor care plans, member status, changes in condition, and progress toward goals; work with members, caregivers, and providers to revise plans as necessary.
- 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 a liaison and member advocate between members and their families, physicians, and facilities or agencies.
- Educate members on and coordinate community resources.
- Coordinate service authorizations for services such as meals, employment, housing, foster care, transportation, and activities of daily living.
- Perform home or other site visits as required to assess member needs and collaborate with resources.
- 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 coaching, facilitating development, and guiding onboarding.
- May support clinical new hires or preceptees in navigating a Managed Care Organization and provide coaching and shadowing to bridge classroom training and 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.
Benefits
- Competitive pay
- Health insurance
- 401(k)
- Stock purchase plans
- Tuition reimbursement
- Paid time off
- 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 program eligibility.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
