Senior LTSS Service Care Manager RN

Centene Management Company•McAllen, TX

24d•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 or physical health needs. Develops personalized long-term care plans and service plans, addresses member needs, and educates members and their families or caregivers about services and benefit options to support appropriate, high-quality care. This is a hybrid role that includes in-home assessments. The employee must reside in Texas and hold the required state licensure. The service delivery area is Donna, Mercedes, or Harlingen, Texas. The role evaluates service needs, develops and continuously assesses care plans, coordinates services among members, caregivers, providers, and community resources, and monitors member status and progress. It also includes documenting care management activities, supporting service authorizations, educating members and caregivers, and advocating for members. The position may involve regular home or other site visits and may include precepting and coaching clinical new hires. The role partners with leadership and cross-functional teams to improve quality and service delivery, performs other assigned duties, and complies with applicable policies and standards.

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.
Resource Utilization Group (RUG) certification must be obtained within 90 days of hire.
Must reside in Texas and be licensed in the state of Texas.

Nice To Haves

Bachelor's degree in Nursing preferred.

Responsibilities

Evaluate service needs of complex or high-risk/high-acuity members and recommend a plan for the best outcome.
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 care between members and their families or caregivers and the care provider team to support 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 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 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 their families or caregivers on disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits.
Act as a liaison and member advocate among members and families, physicians, and facilities or agencies.
Educate members about and coordinate community resources.
Coordinate service authorizations for various services based on assessments and plans, including 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 coaching, building core skills, and guiding onboarding and 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, 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.