Senior LTSS Service Care Manager RN - Pediatrics

Centene Corporation•Austin, TX

12d•$36 - $65•Hybrid

About The Position

The Senior LTSS Service Care Manager RN performs care management for complex and high-acuity pediatric populations with primary medical or physical health needs. The role assesses and coordinates medical and supporting services across the continuum of care to promote quality, cost-effective care. It develops personalized long-term care plans and service plans, addresses member needs, and educates members and their families or caregivers about available services and benefits. This is a hybrid role that includes in-home assessments and requires licensure in Texas. The care manager evaluates service needs, coordinates with members, families, care teams, providers, specialists, and community resources, and monitors member status and progress toward care plan goals. The position also reviews referrals and member data, maintains compliant documentation, facilitates education and service authorizations, and serves as a liaison and advocate for members. The role may include precepting and coaching clinical new hires and supporting their onboarding and readiness for service coordination.

Requirements

Graduate from an accredited School of Nursing or a bachelor's degree, with 4–6 years of related experience.
Current RN state licensure and/or compact state licensure, or current state Nurse Practitioner licensure.
Resource Utilization Group (RUG) certification must be obtained within 90 days of hire.
Must be licensed in Texas.

Nice To Haves

Bachelor's degree in Nursing preferred.

Responsibilities

Evaluate service needs for complex or high-risk/high-acuity members and recommend plans to support the best outcomes.
Develop and continuously assess long-term care plans and service plans, collaborating with care management teams to identify providers, specialists, and community resources.
Coordinate among members, families or caregivers, and care providers to help 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, status changes, and 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 and service 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.
Serve as a liaison and member advocate among 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 in a cost-effective manner.
May precept clinical new hires by coaching, developing core skills, facilitating growth, and guiding onboarding.
May guide and support clinical new hires or preceptees as they navigate a Managed Care Organization, including coaching and shadowing to bridge classroom training and field practice.
May assist new hires or preceptees during onboarding, complete competency checkpoints, and 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.