Senior LTSS Service Care Manager (RN) - J01077

BravoTech; Lubbock (TX); On-site; USD 60,000 - 75,000; Full time

Job summary

A leading healthcare organization seeks a Registered Nurse in Lubbock, Texas to perform care management for complex populations. The role involves developing care plans, coordinating services, and educating members and families on healthcare options. Ideal candidates will possess an RN license and relevant experience, along with a drive for quality and cost-effective care.

Qualifications

• RN licensure and/or compact state licensure required.
• Preferably a bachelor's degree in Nursing.
• 4-6 years of related experience necessary.

Responsibilities

• Assesses and coordinates care for high-need populations.
• Develops and monitors personalized care plans.
• Educates members and families about available services.

Skills

Care Coordination

Patient Education

Team Collaboration

Data Analysis

Education

Bachelor's degree in Nursing

Graduate from an accredited school of nursing

Job description

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.

Education / Experience :

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

License / Certification :

RN - Registered Nurse - State licensure and/or compact state licensure required. For superior performance, Resource Utilization Group (RUG) certification is required.

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 the care management team to identify providers, specialists, and community resources needed to address members' needs.

Coordinates and manages communication between the member and / or family / caregivers and the care provider team to ensure members receive adequate and appropriate person-centered care or services.

Monitors care plans / service plans and member status, changes in condition, and progress towards goals; collaborates with members, caregivers, and providers to revise or update plans as necessary.

Monitors member status for complications and clinical symptoms, assessing needs for potential entry into a higher level of care and / or waiver eligibility.

Reviews member data to identify trends and improve operating performance and quality care in accordance with regulations.

Reviews referrals and assessments to develop appropriate care plans / service plans.

Collaborates with healthcare providers to facilitate member services and treatments, revising care plans as needed.

Documents and maintains all member information and care activities to ensure compliance with guidelines.

Provides education to members and families / caregivers on disease processes, care gaps, provider instructions, options, referrals, and benefits.

Acts as a liaison and advocate between members / families, physicians, and facilities / agencies.

Coordinates community resources and service authorizations based on assessments and plans (e.g., meals, housing, transportation).

May perform home or site visits to assess needs and collaborate with resources.

Partners with leadership to improve quality and cost-effectiveness of care.

May precept new clinical hires, coaching and guiding their development and onboarding.

Supports new hires during onboarding, ensuring competency and readiness.

Collaborates with teams to monitor and measure readiness.

Performs other duties as assigned and complies with policies and standards.