Senior LTSS Service Care Manager RN

Centene Management Company•Austin, TX

18d•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 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 involving in-home assessments in the Killeen and Temple service delivery area. The role evaluates service needs, develops and monitors care plans, coordinates with members, caregivers, providers, and community resources, and tracks changes in member condition and progress toward care goals. It also includes documenting care management activities, facilitating education and service authorizations, advocating for members, and collaborating with leadership to improve quality and cost-effective service delivery. The position may support onboarding and precepting clinical new hires and perform other assigned duties while complying with policies and standards.

Requirements

Graduate of 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 or high-risk/high-acuity members and recommend plans to achieve the best outcomes.
Develop and continually assess long-term care plans and service plans, collaborating with the care management team to identify providers, specialists, and community resources.
Coordinate between members or their families/caregivers and care providers to 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, 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 and service plans.
Collaborate with healthcare providers to facilitate services or treatments and revise member 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/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 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 monthly or more frequently, to assess 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, fostering core skills, and supporting onboarding and readiness.
May guide 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 confirm 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.