Pediatric Senior LTSS Service Care Manager

4 weeks ago

HIALEAH, United States Disability Solutions Full time

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.

This position is remote/work-from-home, and member visits are required. Candidates should reside in the Tampa, FL, area to be considered for this position. RN or LPN candidates are strongly preferred, and pediatric experience is strongly preferred.

Position Purpose: Assesses, plans, implements, and coordinates holistic care management activities to enable quality, cost- effective healthcare outcomes. May develop or assist with developing a personalized care plans/service plans for long-term care members and educates members and their families/caregivers on services and benefits available to meet member needs.

  • Assists with developing and continuously assessing ongoing long-term care plans and works to identify providers, specialist, and/or community resources needed for long-term care
  • Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members
  • Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs
  • Identifies problems/barriers for long-term care management and appropriate care management interventions
  • Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans
  • Reviews long-term care 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 assist with developing appropriate long- term care plans/service plans
  • Collaborates with healthcare providers/partners as appropriate to facilitate member care to ensure member needs are met and determine a revised service plan/care plan for member if needed
  • May perform home and/or other site visits to assess member’s needs and collaborate with healthcare providers and partners
  • Collects, documents, and maintains long-term care member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
  • Provides and/or facilitates education to members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits
  • Partners with leadership team to improve and enhance quality of care and service delivery for long-term members in a cost-effective manner
  • Provides overall guidance and training to other team members within team
  • May assist with additional assignments, projects or other support as needed
  • Performs other duties as assigned
  • Complies with all policies and standards

Education/Experience: Requires a Bachelor's degree and 4 – 6 years of related experience.

Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

Pay Range: $29.43 - $52.98 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.

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