Senior LTSS Service Care Manager RN - Pediatrics

Centene Corporation•San Antonio, TX

12d•$36 - $65•Hybrid

About The Position

Performs care management duties for complex and high-acuity populations with primary medical and physical health needs. Assesses and coordinates medical and supporting services across the continuum of care to promote quality, cost-effective care. Develops personalized long-term care and service plans, addresses member issues, and educates members and their families or caregivers about services and benefit options. This hybrid role requires face-to-face assessments and residence in the San Antonio, Texas area. Pediatric experience is required. The role monitors member conditions and progress, coordinates person-centered services with families, caregivers, providers, and community resources, and maintains documentation in accordance with applicable state, federal, and clinical guidelines. It may also involve home or other site visits and coaching or precepting clinical new hires. Requires graduation from an accredited school of nursing or a bachelor's degree and 4–6 years of related experience. A bachelor's degree in nursing is preferred. An RN state or compact-state license, or an NP license in the current state, is required. Resource Utilization Group (RUG) certification must be obtained within 90 days of hire. Pay range is $36.21–$65.09 per hour.

Requirements

Pediatric experience is required.
Must be licensed and reside in the San Antonio, Texas area.
Graduate from an accredited school of nursing or a bachelor's degree.
4–6 years of related experience.
RN state licensure and/or compact-state licensure, or current state nurse licensure as an NP.
RUG certification must be obtained within 90 days of hire.

Nice To Haves

Bachelor's degree in Nursing preferred.

Responsibilities

Evaluate service needs of complex or high-risk/high-acuity members and recommend plans to support the best outcomes.
Develop and continuously assess long-term care and service plans, collaborating with the care management team to identify providers, specialists, and community resources.
Coordinate between members or their families and caregivers and care provider teams to ensure 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 members for complications, clinical symptoms, and other status changes, including possible need for a higher level of care or waiver eligibility.
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.
Collaborate with healthcare providers to facilitate services or treatments and revise care plans when needed.
Collect, document, and maintain member information and care management activities in compliance with applicable state, federal, and clinical guidelines.
Provide or facilitate education for members and their families or caregivers on disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits.
Act as a liaison and advocate between members and families, physicians, and facilities or agencies.
Educate members about and coordinate community resources and service authorizations for services such as meals, employment, housing, foster care, transportation, and activities of daily living.
Perform 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 cost-effectively.
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 connect classroom training with field practice.
May assist new hires or preceptees during onboarding, complete competency checkpoints, and assess readiness for service coordination.
Work collaboratively with people leaders and cross-functional teams to measure and monitor readiness.
Perform other duties as assigned.
Comply with all policies and standards.