Senior LTSS Service Care Manager RN

Centene Management Company•Waco, TX

1d•Hybrid

About The Position

Centene is seeking a Senior LTSS Service Care Manager RN to join their team. This role involves assessing members in nursing facilities or their homes upon discharge, with mileage reimbursement provided. The primary purpose is to perform care management duties, assessing and coordinating medical and supporting services for complex, high-acuity populations with primary medical/physical health needs. The goal is to promote quality, cost-effective care by developing personalized care plans, addressing issues, and educating members and their families/caregivers on available services and benefits.

Requirements

Graduate from an Accredited School of Nursing
4–6 years of related clinical nursing experience
RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Critical thinking skills and ability to use nursing judgement to assess member’s health risks to ensure member safety
Strong clinical documentation and time management skills
Flexibility, resilience, and excellent interpersonal communication skills for member advocacy
Reliable transportation

Nice To Haves

Bachelor's degree in Nursing preferred
Resource Utilization Group (RUG) certification must be obtained within 90 days of hire required
Clinical RN or Case Management experience in Nursing Facilities, LTC, SNF, Home Health, and/or Hospice settings
Service Coordination with community partners as well as Waiver programs.
Current or previous government-sponsored healthcare experience preferred

Responsibilities

Evaluates the service needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome.
Develops and continuously assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed to address member's needs.
Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services.
Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / needs.
Monitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicable.
Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations.
Reviews referrals information and intake assessments to develop appropriate care plans / service plans.
Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed.
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines.
Provides and/or facilitates education to long-term care members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits.
Acts as liaison and member advocate between the member/family, physician, and facilities/agencies.
Educates on and coordinates community resources. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living).
May perform home and/or other site visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required.
Partners with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner.
May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness.
May provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice.
May engage and assist New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success.
Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness.
Performs other duties as assigned.
Complies with all policies and standards.