Senior LTSS Service Care Manager – RN

Senior LTSS Service Care Manager – RN

Requirements

• Pediatric RN experience is required
• Associates or Bachelor’s degree in Nursing
• 4 – 6 years of experience
• RN – Registered Nurse – State Licensure and/or Compact State Licensure required
• Resource Utilization Group (RUG) certification must be obtained within 90 days of hire required

Responsibilities

• 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
• Develops a personalized care plan/service plan for long-term care members
• 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
• Monitors member status for complications and clinical symptoms or other status changes
• 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
• May perform home and/or other site visits
• 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
• May provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO)
• May engage and assist New Hire/Preceptee during onboarding journey
• 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

Preferred Qualifications

• Clinical pediatric RN nursing experience with direct patient care with MDCP conditions and/or administering medically approved Medicaid assessments and coordinating referrals for medical services
• Pediatrics, NICU, PICU, Pediatric CICU, Pediatric ER
• Pediatric Home Health or Private Duty Nursing
• Pediatric Case Management
• STAR Kids Service Coordination
• Managed Care