Senior LTSS Service Care Manager RN

Centene Corporation • Corpus Christi, TX

21d • $36 - $65 • 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 and physical health needs. The role promotes quality, cost-effective care; develops personalized care plans for long-term care members; addresses care issues; and educates members and their families or caregivers about services and benefit options. This is a hybrid role involving in-home assessments, with a service delivery area in the Beeville, Victoria, or Refugio area.

Requirements

• Graduate from an accredited School of Nursing or hold a bachelor's degree and have 4–6 years of related experience.
• RN state licensure and/or compact state licensure, or current state nurse licensure as an NP.
• Obtain Resource Utilization Group (RUG) certification 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 achieve the best outcomes.
• Develop and continuously assess long-term care plans and collaborate with the care management team to identify providers, specialists, and community resources.
• Coordinate between members, families or caregivers, and care providers 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, 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 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 liaison and member advocate among members and families, physicians, and facilities or agencies.
• Educate members on 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, developing core skills, supporting onboarding, and guiding readiness for field practice.
• May guide clinical new hires or preceptees in navigating a Managed Care Organization and provide coaching and shadowing opportunities.
• May assist new hires or preceptees during onboarding, including completing competency checkpoints to assess readiness for Service Coordination.
• Collaborate with People Leaders and cross-functional teams to measure and monitor readiness.
• Perform other duties as assigned.
• Comply with all policies and standards.

Benefits

• Competitive pay
• Health insurance
• 401K
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior