Senior LTSS Service Care Manager (RN)

Spectraforce Technologies; McAllen (TX); Hybrid; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a Senior LTSS Service Care Manager (RN) to enhance care for complex populations. This role involves assessing and coordinating medical services, developing personalized care plans, and educating members and families about available resources. The ideal candidate will possess strong care management skills and a passion for improving patient outcomes. Join a dynamic team that values collaboration, mentorship, and high-quality care delivery. If you are a dedicated RN with a commitment to excellence, this opportunity is perfect for you.

Qualifications

• Graduation from an accredited nursing school or Bachelor's degree with 4-6 years of experience.
• RN or NP licensure required; Pediatric experience preferred.

Responsibilities

• Evaluate service needs of high-risk members and recommend optimal care plans.
• Coordinate between members, families, and providers to ensure person-centered care.

Skills

Care Management

Assessment Skills

Communication Skills

Patient Advocacy

Collaboration

Education

Bachelor's in Nursing

Graduation from an accredited nursing school

Tools

Microsoft Teams

Outlook

Excel

Word

Job description

Title: Senior LTSS Service Care Manager (RN)

Duration: 06 Months - Possibility to extend

Location: Texas - Hidalgo SDA - Brownsville and surrounding cities/towns. Travel to member homes 3 days a week to complete assessments, 2 days remote

Position Purpose:

Note: For use by Arizona, Superior, and Sunflower only.

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 personalized care and service plans for long-term care members, addressing issues, and educating members and their families/caregivers on available services and benefit options to ensure high-quality care.

Education/Experience:

Requires graduation from an accredited nursing school or a bachelor's degree with 4-6 years of related experience. Bachelor's in Nursing preferred.

License/Certification:

RN - Registered Nurse with State Licensure and/or Compact State Licensure required or
NP - Nurse Practitioner with current State Licensure required. For Superior: Resource Utilization Group (RUG) certification required.

Responsibilities include:

• Evaluating service needs of complex or high-risk members and recommending optimal plans.
• Developing and assessing long-term care plans in collaboration with care teams.
• Coordinating between members, families, caregivers, and providers to ensure person-centered care.
• Monitoring care plans, member status, and revising plans as needed.
• Reviewing member data for trends to improve quality and compliance.
• Collaborating with healthcare providers to facilitate services and treatments.
• Maintaining all member information and documentation for compliance.
• Providing education to members and families on health conditions, services, and benefits.
• Acting as a liaison and advocate for members and families.
• Coordinating community resources and service authorizations.
• Performing site visits to assess member needs.
• Partnering with leadership to enhance quality and cost-effective care.
• Mentoring new hires and preceptees, supporting onboarding and training processes.
• Engaging with teams to monitor and measure readiness.
• Performing other duties as assigned and ensuring compliance with policies.

Additional duties include:

• Completing assessments, biannual reviews, telephonic outreaches, and care coordination.
• Following up on member requests, documentation, and authorizations.
• Traveling for home assessments and maintaining audit scores of at least 92%.
• Providing education to members and caregivers, and assisting with healthcare provider connections.

Education/Certification:

Licensure

Required: RN License

Preferred: Pediatric experience, Outlook, Excel, Word, Microsoft Teams skills