Senior LTSS Service Care Manager RN

Centene Management Company•Corpus Christi, TX

20d•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. Promotes quality, cost-effective care by developing personalized long-term care or service plans, addressing issues, and educating members and their families or caregivers about available services and benefits. This is a hybrid role involving in-home assessments in the Beeville, Victoria, or Refugio service area. The role evaluates the service needs of high-risk members, develops and continually assesses care plans, coordinates providers and community resources, monitors member status and progress, and supports appropriate service authorization. It includes educating and advocating for members, maintaining compliant documentation, and collaborating with healthcare providers and internal teams. The position may also support the onboarding and development of clinical new hires and perform other assigned duties while complying with company policies and standards.

Requirements

Graduate from an accredited School of Nursing or a bachelor's degree and 4–6 years of related experience.
RN (Registered Nurse) state licensure and/or compact state licensure, or current state Nurse Practitioner licensure, 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 members and recommend plans to achieve the best outcomes.
Develop and continually assess long-term care plans or service plans, collaborating with the care management team to identify appropriate providers, specialists, and community resources.
Coordinate care between members, families or caregivers, and care providers to support adequate, appropriate, person-centered 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 changes, including needs for a higher level of care or waiver eligibility when 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 or service plans.
Collaborate with healthcare providers to facilitate services or treatments and revise member care plans when needed.
Collect, document, and maintain member information and care management activities in compliance with state, federal, and clinical guidelines.
Educate 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 among members or families, physicians, and facilities or agencies.
Educate members on and coordinate community resources.
Coordinate service authorization for services such as meals, employment, housing, foster care, transportation, and activities of daily living.
Perform 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 them, fostering core skills, and guiding their onboarding and readiness.
May guide and 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, 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 and comply with all policies and standards.