Senior LTSS Service Care Manager RN

iHire; Mission (TX); Hybrid; USD 60,000 - 80,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated care management professional to join their team. This role focuses on assessing and coordinating care for complex populations, ensuring members receive high-quality services tailored to their needs. You'll have the opportunity to develop personalized care plans, collaborate with healthcare providers, and advocate for members and their families. The position offers a flexible work environment, competitive pay, and a comprehensive benefits package, making it an exciting opportunity for those looking to make a meaningful impact in the healthcare sector. If you're passionate about improving lives and enhancing care delivery, this role is perfect for you.

Benefits

Health Insurance

401K Plan

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• Requires RN or NP licensure and 4-6 years of related experience.
• Bachelor's degree in Nursing preferred for this role.

Responsibilities

• Evaluate service needs of high-risk members and develop care plans.
• Coordinate care between members, families, and healthcare providers.
• Educate members and families on healthcare options and benefits.

Skills

Care Management

Patient Advocacy

Assessment Skills

Collaboration

Education and Training

Education

Bachelor's Degree in Nursing

Graduate from an Accredited School of Nursing

Tools

Electronic Health Records (EHR)

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

Must be licensed and reside in Texas near the SDA

Service Delivery Area is McAllen, Pharr, Hidalgo area.

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.

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 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; collaborates 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.
• Complies with all policies and standards.

Education/Experience:

Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 4-6 years of related experience. Bachelor's degree in Nursing preferred.

License/Certification:

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required or
• NP - Nurse Practitioner - Current State's Nurse Licensure required.
• For Superior: Resource Utilization Group (RUG) certification must be obtained within 90 days of hire required.

Pay Range:

$35.49 - $63.79 per hour.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.