Senior LTSS Service Care Manager RN - Pediatrics

Centene Management Company•San Antonio, TX

11d•Hybrid

About The Position

Performs care management duties to assess and coordinate medical and supporting services across the continuum of care for complex or high-acuity populations with primary medical or physical health needs. The role promotes quality, cost-effective care by developing personalized long-term care and service plans, addressing members’ needs, and educating members and their families or caregivers about available services and benefits. This is a hybrid role requiring face-to-face assessments. The employee must be licensed and reside in the San Antonio, Texas area, and pediatric experience is required. The position evaluates service needs, develops and monitors care plans, coordinates with members, caregivers, providers, specialists, and community resources, and monitors changes in member condition and progress toward goals. It also includes documenting care management activity, facilitating education and service authorizations, advocating for members, and coordinating community resources. The role may include home or other site visits and may involve precepting and supporting clinical new hires. Other duties may be assigned, and the employee must comply with all policies and standards.

Requirements

Graduate of an accredited school of nursing or a bachelor's degree and 4–6 years of related experience.
Pediatric experience required.
Must be licensed and reside in the San Antonio, Texas area.
Current RN state licensure and/or compact state licensure, or current state nurse licensure as a Nurse Practitioner, required.
Resource Utilization Group (RUG) certification required within 90 days of hire.

Nice To Haves

Bachelor's degree in Nursing preferred.

Responsibilities

Evaluate the service needs of complex or high-risk/high-acuity members and recommend a plan for the best outcome.
Develop and continuously assess long-term care plans and service plans; collaborate with the care management team to identify providers, specialists, and community resources.
Coordinate between members or their families/caregivers and the care provider team to ensure adequate, 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 for complications, clinical symptoms, or other status changes, including potential 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 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 state, federal, and clinical guidelines.
Provide or facilitate education for members and families/caregivers about disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits.
Act as a liaison and member advocate between members or 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.
Conduct home or other site visits, potentially once a month or more, 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 in a cost-effective manner.
May precept clinical new hires by coaching, building core skills, facilitating growth, and supporting onboarding.
May guide and 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, including completing competency checkpoints and assessing readiness for service coordination.
Work collaboratively with People Leaders and cross-functional teams to measure and monitor readiness.
Perform other duties as assigned and comply with all policies and standards.