Senior LTSS Service Care Manager, RN

Centene • Dallas, TX

111d • $35 - $63

About The Position

As a Senior LTSS Service Care Manager, RN, you will perform care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs. Your role will involve developing personalized care plans for long-term care members, addressing issues, and educating members and their families on available services and benefits. You will evaluate service needs, recommend plans for optimal outcomes, and collaborate with care management teams to identify necessary providers and resources. Additionally, you will monitor care plans, assess member status, and ensure compliance with state and federal regulations. This position requires home visits and collaboration with healthcare providers to facilitate member services.

Requirements

• Graduate from an Accredited School of Nursing or a Bachelor's degree.
• 4-6 years of related experience.
• RN - Registered Nurse - State Licensure and/or Compact State 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

• Perform care management duties to assess and coordinate medical and supporting services for complex/high acuity populations.
• Develop personalized care plans for long-term care members.
• Evaluate service needs and recommend plans for optimal outcomes.
• Collaborate with care management teams to identify necessary providers and resources.
• Monitor care plans and member status, revising as necessary.
• Review member data to identify trends and improve quality care.
• Educate long-term care members and their families on healthcare options and benefits.
• Act as a liaison and advocate between members, families, and healthcare providers.
• Coordinate service authorization for various services based on assessments.
• May perform home visits to assess member needs.
• Partner with leadership to improve quality of care and service delivery.
• Precept clinical new hires and provide guidance during onboarding.
• Engage in collaborative processes with cross-functional teams.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible work schedules (remote, hybrid, field, or office).

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree