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Senior LTSS Service Care Manager, RN

1 month ago

Corpus Christi, Texas, United States Centene Corporation Full time
Job Title: Senior LTSS Service Care Manager, RN

Centene is seeking a Senior LTSS Service Care Manager, RN to join our team. As a Senior LTSS Service Care Manager, you will be responsible for performing care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations.

Key Responsibilities:
  • Evaluate the service needs of the most complex or high risk/high acuity members and recommend a plan for the best outcome
  • Develop and continuously assess ongoing long-term care plans / service plans and collaborate with care management team to identify providers, specialists, and/or community resources needed to address member's needs
  • Coordinate and manage 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
  • Monitor 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
  • Monitor 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
  • Travel is 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.