Senior LTSS Service Care Manager RN

Centene Corporation•Killeen, TX

19d•$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 and service plans for long-term care members; addresses issues; and educates members and their families or caregivers about available services and benefit options. This is a hybrid role that includes in-home assessments, with a service delivery area covering Killeen and Temple.

Requirements

Graduate from an accredited School of Nursing or hold a bachelor's degree and have 4–6 years of related experience.
RN registered nurse state licensure and/or compact state licensure, or current state nurse licensure as an NP, required.
Resource Utilization Group (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 for the best outcome.
Develop and continuously assess long-term care plans and collaborate with care management teams to identify providers, specialists, and community resources.
Coordinate between members and their families or caregivers and care provider teams to support 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 members for complications, clinical symptoms, and other status changes, including 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.
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 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 about 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 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, building core skills, supporting growth, and guiding 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 to assess readiness for Service Coordination.
Engage in an ongoing collaborative process with People Leaders and cross-functional teams to measure and monitor readiness.
Perform other duties as assigned.
Comply with all policies and standards.