Senior LTSS Service Care Manager RN

1 week ago

TX United States Centene Corporation Full time
Job Title: Senior LTSS Service Care Manager RN

Join Centene Corporation, a leading healthcare company, as a Senior LTSS Service Care Manager RN. In this role, you will play a critical part in transforming the health of our communities, one person at a time.

About the Role:

As a Senior LTSS Service Care Manager RN, you will be responsible for assessing and coordinating all aspects of medical and supporting services across the continuum of care for complex/high acuity populations. Your primary goal will be to promote quality, cost-effective care by developing personalized care plans and addressing issues that impact our members' health outcomes.

Key Responsibilities:
  • Evaluate the service needs of our 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 the care management team to identify providers, specialists, and/or community resources needed to address members' 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 members, caregivers, and appropriate providers to revise or update care plans/service plans as necessary to meet the members' 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.
  • Review member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations.
  • Review referrals information and intake assessments to develop appropriate care plans/service plans.
  • Collaborate with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for members if needed.
  • Collect, document, and maintain all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines.
  • Provide and/or facilitate 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.
  • Act as liaison and member advocate between the member/family, physician, and facilities/agencies.
  • Educate on and coordinate community resources. Provide 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 the 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.
Requirements:
  • 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
    • For Superior: Resource Utilization Group (RUG) certification must be obtained within 90 days of hire required
What We Offer:

Centene Corporation 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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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