LTSS Care Manager
1 month ago
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose:
(Location Wake County)
- Provides care coordination and care management and oversees higher acuity long-term support services / long-term care members. (i.e. individuals with complex medical or behavioral health issues that place populations at greater risk for potentially prevent able events such as avoidable admissions, readmissions, and emergency room visits).
- Manages an active caseload based on state mandated ratios according to residential setting, case intensity and acuity.
- Partners effectively with the PCP, Specialist, member, member's family and interdisciplinary care teams (ICT) to develop a Person Centered Care Plan
- Utilizes clinical knowledge and expertise to craft strategies aimed at member education to support self-management and achieve optimal health outcomes
- In partnership with the member, family, physician(s), ICT and other providers, assesses short and long-term member needs, evaluates the need for supportive e services and establishes member driven care management objectives.
- Responsible for coordination of service authorizations (i.e. meals, transportation, activities of daily living).
- Performs clinical interventions such as education on prescribed medication treatment regimens and counseling.
- Ensures comprehensive assessments and person-centered care plans are completed within required time frames and utilizes clinical knowledge and expertise to assess options for care including use of benefits and community resources.
- Acts as liaison and member advocate between the member/family, physician and facilities/agencies.
- Maintains accurate reports and manages the integrity of care management activities in the electronic care management system, using clinical guidelines.
- Educates on and coordinates community resources, to include medical, behavioral and social services.
- Applies care management standards and maintains HIPAA standards and confidentiality of protected health information.
- Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
- Participates in performance improvement activities.
- Performs special projects as assigned.
- Additional Responsibilities:
- Performs other duties as assigned
- Complies with all policies and standards
This licensed professional will be responsible for the oversight and coordination of long term support services / long term care for special (higher acuity) populations residing in the community and/or skilled nursing facilities. Examples include but are not limited to: individuals with 2 or more, higher risk medical or behavioral health conditions (e.g., COPD and Schizophrenia). This position assumes a leadership role with internal and external partners to achieve optimal health care outcomes for the member through effective coordination of care activities.
Education/Experience:
Bachelor's degree in nursing, or Master's degree in social work, sociology, psychology, gerontology, or a related social services field.
Licenses and Certifications: A license in one of the following is required:
Required Other One of the following licenses is required (must be licensed in the state of practice): Registered Nurse (RN)
Licensed Certified Social Worker (LCSW)
For North Carolina Standard Plan: Two (2) years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience;
Prior experience with social work, geriatrics, gerontology, pediatrics, or human services. RN or LCSW required.
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.
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