Senior LTSS Service Care Manager (RN)
About The Position
Performs care management duties for complex or high-acuity populations with primary medical and physical health needs, assessing and coordinating medical and supporting services across the continuum of care to promote quality, cost-effective care. Develops personalized long-term care and service plans, addresses member needs, and educates members and their families or caregivers about available services and benefits. This hybrid position includes remote work from home and member home visits in Brownsville, Harlingen, and San Benito, Texas. Travel is required for member visits, with mileage reimbursement provided. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. CST, with no on-call duties, evenings, weekends, or holidays. The role may include precepting and coaching clinical new hires, supporting onboarding and competency checks, and collaborating with leaders and cross-functional teams to assess readiness. Other duties may be assigned, and the role must comply with applicable policies and standards.
Requirements
- Graduate of 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 practitioner licensure.
- Resource Utilization Group (RUG) certification must be obtained within 90 days of hire for Superior.
- Travel is required for member visits.
- Experience in RN care coordination or case management with adult members age 21 or older in Home Health, Hospice, Long-Term Care, or Managed Care is preferred.
Nice To Haves
- Bachelor's degree in Nursing.
- Experience in RN care coordination or case management with adult members (21 or older) in Home Health, Hospice, Long-Term Care, or Managed Care.
Responsibilities
- Evaluate service needs of complex or high-risk/high-acuity members and recommend plans to support the best outcomes.
- Develop and continuously assess long-term care 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 ensure adequate, appropriate, person-centered 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 assessing potential need 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 referrals and intake assessment information to develop appropriate care plans and service plans.
- Collaborate with healthcare providers to facilitate services or treatments and revise member care plans when needed.
- Collect, document, and maintain member information and care management activities in accordance with 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 a liaison and member advocate among members and families, physicians, and facilities or agencies.
- Educate members about and coordinate community resources and service authorizations based on service assessments and plans, including services such as meals, employment, housing, foster care, transportation, and activities of daily living.
- Conduct 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 the quality, cost-effectiveness, and delivery of services for long-term care members.
- May precept clinical new hires by building core skills, coaching, facilitating growth, and guiding onboarding.
- May guide and support clinical new hires or preceptees as they navigate a Managed Care Organization, including coaching and shadowing to connect classroom training with field practice.
- May assist new hires or preceptees during onboarding, including completing competency checkpoints and assessing 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.
Benefits
- Competitive pay
- Health insurance
- 401(k)
- Stock purchase plans
- Tuition reimbursement
- Paid time off
- Paid holidays
- Flexible work arrangements, including remote, hybrid, field, or office schedules
- Potential additional incentive compensation
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What This Job Offers
Job Type
Full-time
Career Level
Senior
