Senior LTSS Service Care Manager RN - Pediatrics

Centene Management Company LLC; San Antonio (TX); Hybrid; USD 50,000 - 90,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work schedules (remote,Hybrid

Job summary

Centene Management Company LLC is seeking a nurse-led care manager to perform in-home assessments and coordinate comprehensive care for high-acuity populations in Texas. The role requires licensure in Texas and involves developing personalized long-term care plans and educating members and families on available services.

Hybrid position with opportunities to collaborate with a care management team, providers, and community resources to ensure high-quality, cost-effective care delivery.

Qualifications

• Requires Texas license.
• Graduate from an Accredited School of Nursing or a Bachelor's degree with 4–6 years of related experience.
• RN or NP licensure required; RUG certification must be obtained within 90 days of hire.

Responsibilities

• Evaluate the service needs of the most complex or high risk/high acuity members and recommend a plan.
• Develop and assess long-term care/ service plans with care management team.
• Coordinate between member/family and care providers to ensure person-centered care.
• Monitor and revise care plans to meet member goals and needs.
• Educate members and families on disease processes, care options and benefits.
• Act as liaison between member, family, physician and facilities/agencies.

Skills

Care management

In-home assessments

Patient education

Coordination of care

Experience with complex/high-acuity

Education

Graduate from Accredited School of Nursing

Bachelor's degree

RN license

RUG certification within 90 days

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

Must have a Texas license. This is a hybrid role performing in-home assessments.

• 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
• 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 Resource Utilization Group (RUG) certification must be obtained within 90 days of hire required

Pay Range

$36.21 - $65.09 per hour

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Equal Opportunity

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

Additional Information

Thanks for your interest in Centene and its subsidiary companies. We’re so glad that you’ve decided to fill out an application and take the next step to find your purpose. Also, we’re here to help support you on your candidate journey. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.