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Senior LTSS Service Care Manager (RN) - J01077
Job Description
Position Purpose:
**For use by Arizona, Superior, and Sunflower only.**
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.
Education/Experience:
Requires Graduate from an Accredited School or 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 required 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
Comments
source from El Paso, TX. HM requesting all candidates to have 4+ years of RN experience to align with FTE job title description.
Remote and field-based employees are expected to devote their attention to work-related tasks during scheduled working hours.
Acting as a regular and/or primary caretaker for dependents or other household members during working hours is generally not consistent with full-time employment.
Engaging in activities related to home-based businesses, secondary employment, or other matters unrelated to Centene business during scheduled working hours is not permitted and may result in disciplinary action.
No time off or missed training hours or days for 90 days during Core Training
**For use by Arizona, Superior, and Sunflower only.**
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.
Education/Experience:
Requires Graduate from an Accredited School or 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 required 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
Comments
source from El Paso, TX. HM requesting all candidates to have 4+ years of RN experience to align with FTE job title description.
Remote and field-based employees are expected to devote their attention to work-related tasks during scheduled working hours.
Acting as a regular and/or primary caretaker for dependents or other household members during working hours is generally not consistent with full-time employment.
Engaging in activities related to home-based businesses, secondary employment, or other matters unrelated to Centene business during scheduled working hours is not permitted and may result in disciplinary action.
No time off or missed training hours or days for 90 days during Core Training