Senior LTSS Service Care Manager RN

Centene Corporation•Uvalde, TX

20d•$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 and physical health needs. The role promotes quality, cost-effective care; develops personalized care plans or service plans for long-term care members; addresses issues; and educates members and their families or caregivers about available services and benefit options. This is a hybrid role that performs in-home assessments. Uvalde and Del Rio are the service delivery areas. The position may include precepting clinical new hires, coaching them through onboarding and field practice, and assessing readiness for service coordination success. The role also partners with leadership and cross-functional teams to improve quality of care and service delivery. Other duties may be assigned, and the employee must comply with all policies and standards.

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 required, or NP—Nurse Practitioner—current state nurse 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 the most complex or high-risk/high-acuity members and recommend plans for the best outcomes.
Develop and continuously assess ongoing long-term care plans or service plans; collaborate with the care management team to identify providers, specialists, and community resources needed to address member needs.
Coordinate between members or their families/caregivers and care provider teams to help ensure adequate, appropriate, person-centered care or services.
Monitor care plans, member status, changes in condition, and progress toward goals; collaborate with members, caregivers, and providers to revise or update plans as needed.
Monitor members for complications, clinical symptoms, and other status changes, including assessing potential entry into a higher level of care and/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 to ensure compliance with current state, federal, and clinical guidelines.
Provide or facilitate education for long-term care members and their families/caregivers on disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits.
Act as a liaison and member advocate between members or families, physicians, 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, potentially once a month or more, to assess member needs and collaborate with resources, as required.
Partner with the leadership team 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 development, 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 throughout onboarding, including completing competency checkpoints to ensure readiness for service coordination.
Engage in an ongoing, collaborative process with People Leaders and cross-functional teams to measure and monitor readiness.
Perform other duties as assigned.
Comply with all policies and standards.