Senior LTSS Service Care Manager RN

Centene Corporation•Austin, TX

25d•$36 - $65•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. The role promotes quality, cost-effective care and develops personalized care plans or service plans for long-term care members. It addresses member needs and educates members and their families or caregivers about available services and benefit options to help them receive appropriate, high-quality care. This is a hybrid role that includes in-home assessments. The position may involve home or other site visits, such as monthly or more often, to assess member needs and collaborate with resources. The role may also include precepting and supporting clinical new hires during onboarding, including coaching, shadowing, competency checkpoints, and readiness monitoring.

Requirements

Graduate from an accredited school of nursing or a bachelor's degree and 4–6 years of related experience.
RN registered nurse state licensure and/or compact state licensure, or current state nurse licensure as an NP, 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 the most complex or high-risk/high-acuity members and recommend plans to achieve the best outcomes.
Develop and continually 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 and their families or caregivers and care provider teams 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 members for complications, clinical symptoms, or 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 current state, federal, and clinical guidelines.
Provide or facilitate education for long-term care members and their families or caregivers on disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits.
Act as liaison and member advocate among the member or family, physician, and facilities or agencies.
Educate members about and coordinate community resources; coordinate service authorization for services such as meals, employment, housing, foster care, transportation, and activities of daily living.
Perform home or other site visits, as required, to assess member needs and collaborate with resources.
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 growth, and guiding onboarding to improve readiness.
May guide and 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 to ensure readiness for Service Coordination.
Collaborate with People Leaders and cross-functional teams to measure and monitor readiness.
Perform other duties as assigned.
Comply with all policies and standards.