Senior LTSS Service Care Manager RN

Centene Management Company•Austin, TX

23d•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 and develops personalized long-term care and service plans. It addresses member needs and educates members and their families or caregivers about available services and benefit options to support appropriate, high-quality care. This is a hybrid role that includes in-home assessments. The Care Manager evaluates service needs, develops and monitors care plans, coordinates with members, caregivers, providers, and community resources, and advocates for members. The role also supports service authorization, monitors clinical changes and care outcomes, maintains documentation in accordance with applicable guidelines, and may coach and support clinical new hires during onboarding.

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 achieve the best outcomes.
Develop and continuously assess long-term care plans and service plans, collaborating with the care management team to identify providers, specialists, and community resources.
Coordinate between members and their families or caregivers and the care provider team to help ensure 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 assessment needs 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 determine revised care plans when needed.
Collect, document, and maintain member information and care management activities to ensure 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 a liaison and member advocate between members and families, physicians, and facilities or agencies.
Educate members about and coordinate community resources.
Coordinate service authorization for members and care managers for services based on assessments and plans, 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 them, building core skills, facilitating growth, and guiding onboarding.
May 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 responsibilities.
Work collaboratively with People Leaders and cross-functional teams to measure and monitor readiness.
Perform other duties as assigned and comply with all policies and standards.