RN, Senior LTSS Service Care Manager

Centene Corp.; Houston (TX); On-site; USD 539,000 - 895,000; Full time

Benefits offered by this job

Mileage reimbursement

Flexible scheduling for school Calend

Job summary

Centene Corp. in Houston, TX, seeks an experienced Registered Nurse for care management and pediatric case coordination.

You will develop personalized care plans for long-term members and collaborate with families, caregivers and providers to ensure high-quality, cost-effective care across the continuum. The role involves evaluating complex or high-acuity cases, adjusting plans as needs evolve, and educating families on services and benefits.

Qualifications

• Graduate from an Accredited School of Nursing.
• 4–6 years of clinical nursing and/or RN case management or service coordination.
• Bachelor of Nursing degree preferred.

Responsibilities

• Evaluates the service needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome.
• Develops and continuously assesses long-term care plans / service plans with care management team to identify providers and community resources.
• Coordinates between member/family/caregivers and care provider team to ensure comprehensive, person-centered care.
• Monitors progress toward care plan goals and revises plans as needed.
• Educates members and families on disease processes, care options, and benefits.

Skills

Care coordination

Pediatric care

RN licensure

Provider liaison

Home health knowledge

Education

BSN degree

Tools

EMR systems

Job description

**Position Purpose:** Performs 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 to promote quality, cost effective care. Develops a personalized care plan / service plan for long-term care members, addresses issues, and educates members and their families/caregivers on services and benefit options available to receive appropriate high-quality care.**Key Details:** We are seeking an RN with a passion for care coordination and case management, particularly in supporting children and adolescents (ages 0–18) with complex, high-risk, or high-acuity needs. Experience in Home Health, Hospice, Long-Term Care, or Managed Care is highly valued. Standard Monday–Friday schedule from 8:00 AM–5:00 PM CST but will need to be flexible to accommodate our pediatric members school schedules, when needed.**Service Delivery Area: Cypress, TX and the surrounding counties; Mileage reimbursement is provided for member assessment visits.*** Evaluates the service needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome* Develops and continuously assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed to address member's needs* Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services* Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / needs* Monitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicable* Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations* Reviews referrals information and intake assessments to develop appropriate care plans / service plans* Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed* Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines* Provides and/or facilitates education to long-term care members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits* Acts as liaison and member advocate between the member/family, physician, and facilities/agencies* Educates on and coordinates community resources. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living)* May perform home and/or other site visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required* Partners with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner* May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness* May provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice* May engage and assist New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success* Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness* Performs other duties as assigned* Comply with all policies and standards* Travel is required for member assessment visits**Education/Experience:** Requires Graduate from an Accredited School of Nursing and 4–6 years of related experience. Bachelor of Nursing degree is preferred**Preferred Experience:*** 4 - 6 years of clinical nursing and/or RN case management or Service Coordination experience within Pediatric Acute Care, Pediatric Home Health, or Pediatric Private Duty Nursing settings.Pay Range: $36.21 - $65.09 per hour