Senior LTSS Service Care Manager RN
About The Position
Performs care management for complex and high-acuity populations with primary medical and physical health needs. Assesses and coordinates medical and supporting services across the continuum of care to promote quality, cost-effective outcomes. Develops personalized care and service plans for long-term care members, addresses identified issues, and educates members and their families or caregivers about available services and benefit options. This is a hybrid role involving in-home assessments. The employee must reside in Texas and hold the required Texas or compact-state licensure. The service delivery area is Donna, Mercedes, or Harlingen. The role may also involve precepting clinical new hires, supporting onboarding and readiness, and working with People Leaders and cross-functional teams to monitor readiness. Other duties may be assigned, and the employee must comply with all policies and standards.
Requirements
- Graduate from an accredited School of Nursing or have a bachelor's degree and 4–6 years of related experience.
- RN state licensure and/or compact-state licensure, or current state nurse licensure as a Nurse Practitioner.
- Obtain Resource Utilization Group (RUG) certification 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 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 care among members, families or caregivers, and care providers 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 needs for a higher level of care or waiver eligibility.
- 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 revise 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 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 authorizations for 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 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, developing core skills, supporting onboarding, and building readiness.
- May guide and support clinical new hires or preceptees in navigating a Managed Care Organization and provide coaching and shadowing to connect classroom training with field practice.
- May support new hires or preceptees during onboarding, complete competency checkpoints, and assess readiness for service coordination.
- 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.
Benefits
- Competitive pay
- Health insurance
- 401(k) and stock purchase plans
- Tuition reimbursement
- Paid time off and holidays
- Flexible approach to work, with remote, hybrid, field, or office schedules
- Additional forms of incentives may be included in total compensation, subject to applicable conditions
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What This Job Offers
Job Type
Full-time
Career Level
Senior
