Senior Care Manager RN — Lead Care Planning & Coordination

Superior HealthPlan; Austin (TX); Vor Ort; USD 75.000 - 135.000; Vollzeit

Zusammenfassung

Superior HealthPlan is seeking a Senior Care Manager RN to assess, plan, and implement complex care management activities, developing personalized care/service plans and educating members and families on available services and benefits.

The role focuses on coordinating with providers, monitoring progress, and ensuring high-quality, cost-effective care for members with chronic conditions and preventive needs.

Qualifikationen

• Requires a degree in nursing or RN licensure with at least 4–6 years of related experience.
• RN licensure required.
• Preferred: 7+ years RN clinical nursing experience with direct patient care.

Aufgaben

• Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs.
• Coordinates and manages between the member and/or family/caregivers and the care provider team to ensure members are receiving appropriate person-centered care or services
• Monitors care plans / service plans and/or member status, change in condition, and progress towards goals; collaborate with member, caregivers, and appropriate providers to revise plans as necessary
• Identify problems/barriers for care management and appropriate interventions for escalated cases
• Review member data to identify trends and improve operating performance and quality care in accordance with regulations
• Review referrals information and intake assessments to develop appropriate care plans/service plans
• May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
• Collaborates with healthcare providers to facilitate member services and determine revised care plan when needed
• Collects, documents, and maintains all member information and care management activities to ensure compliance
• Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, provider instructions, care options, referrals, and benefits
• Partners with leadership to improve care and quality delivery cost-effectively
• Precepts clinical new hires, coaching and onboarding readiness
• Assists in onboarding journey ensuring readiness for Service Coordination success
• Collaborates with People Leaders and cross-functional teams to measure readiness
• Other duties as assigned to meet business needs
• Complies with all policies and standards.

Kenntnisse

Clinical nursing

Care coordination

Patient education

Documentation

Communication

Ausbildung

Bachelor's degree in Nursing

Jobbeschreibung

Superior HealthPlan is seeking a Senior Care Manager RN to assess, plan, and implement complex care management activities, developing personalized care/service plans and educating members and families on available services and benefits.

The role focuses on coordinating with providers, monitoring progress, and ensuring high-quality, cost-effective care for members with chronic conditions and preventive needs.