Care Manager Jobs

About The Position

Requirements

• Graduate from an accredited school of nursing.
• Four to six years of related clinical nursing and/or case management and care coordination experience.
• Experience in care coordination and/or case management with adult members age 21 or older in Behavioral Health, Home Health, Long-Term Care, Managed Care, Nursing Rehabilitation, or a skilled nursing facility (SNF).
• Current RN state licensure and/or compact state licensure, or current state Nurse Practitioner licensure.
• For Superior Health Plan, obtain Resource Utilization Group (RUG) certification within 90 days of hire.
• Travel for member visits is required.

Nice To Haves

• Bachelor of Nursing degree preferred.

Responsibilities

• Evaluate service needs for 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 between members, families or caregivers, and care providers to help ensure adequate, appropriate, person-centered care.
• Monitor care plans, member status, changes in condition, and progress toward goals; collaborate with members, caregivers, and providers to revise plans as needed.
• Monitor for complications, clinical symptoms, status changes, and 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 assessments to develop appropriate care plans and 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 accordance with state, federal, and clinical guidelines.
• Educate or facilitate education for members and their families or caregivers on disease processes, care gaps, provider instructions, care options, referrals, and healthcare benefits.
• Act as a liaison and advocate among 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.
• Conduct 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, developing core skills, and guiding onboarding.
• May support clinical new hires or preceptees in navigating a Managed Care Organization, providing coaching and shadowing to bridge classroom training and field practice.
• May support 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) plan
• Stock purchase plans
• Tuition reimbursement
• Paid time off
• Paid holidays
• Flexible approach to work, including remote, hybrid, field, or office work schedules
• Additional forms of incentives may be included in total compensation