Senior LTSS Service Care Manager RN

Centene Management Company•Lubbock, TX

19d•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. Develops personalized long-term care and service plans, addresses care issues, and educates members and their families or caregivers about services and benefits that support appropriate, high-quality care. This is a hybrid role involving in-home assessments in the Uvalde and Del Rio service delivery areas. The role evaluates service needs, develops and monitors care plans, coordinates providers and community resources, tracks member status and progress, and revises plans as needed. It includes documentation and compliance responsibilities, member and caregiver education, advocacy, coordination of service authorizations, and collaboration with healthcare providers, leadership, and cross-functional teams. The position may also involve site visits and precepting or coaching clinical new hires.

Requirements

Graduate from an accredited School of Nursing or a bachelor's degree and 4–6 years of related experience.
RN state licensure and/or compact state licensure, or current state Nurse Practitioner licensure, 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, high-risk, or high-acuity members and recommend plans to support the best outcomes.
Develop and continuously assess long-term care plans or service plans, collaborating with the care management team to identify providers, specialists, and community resources.
Coordinate care between members or their families and caregivers and the care provider team to ensure adequate, appropriate, person-centered care or 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 or 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 or caregivers about disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits.
Act as a liaison and advocate between members or families, physicians, and facilities or agencies.
Educate members about and coordinate community resources.
Coordinate service authorizations for members and care managers based on service assessments and plans, including 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 building core skills, coaching and facilitating development, and guiding onboarding to improve readiness.
May 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 ensuring readiness for Service Coordination work.
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.