Telephonic Case Manager
Sedgwick
Senior LTSS Service Care Manager, RN
Centene Corporation
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $35 - $64 per hour
Job Level
Senior
About the role
- 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 and educates members and families/caregivers on services and benefit options
- Evaluates service needs of complex or high risk/high acuity members and recommends plans for best outcomes
- Continuously assesses and updates long-term care plans and collaborates with care management team to identify providers and community resources
- Coordinates between member/family/caregivers and the care provider team to ensure person-centered care
- Monitors member status, change in condition, and progress towards care plan goals; revises plans as necessary
- Reviews referrals and intake assessments to develop appropriate care plans
- Collaborates with healthcare providers to facilitate services/treatments and determine revised care plans
- Collects, documents, and maintains member information to ensure compliance with state, federal, and clinical guidelines
- Provides and/or facilitates education on disease processes, resolving care gaps, referrals, and benefits
- Acts as liaison and member advocate between member/family, physician, and facilities/agencies
- Educates on and coordinates community resources and service authorizations (meals, employment, housing, transportation, ADLs)
- May perform home and/or site visits to assess member needs and collaborate with resources
- Partners with leadership to improve quality of care and service delivery and may precept clinical new hires
Requirements
- Graduate from an Accredited School of Nursing or a Bachelor's degree
- 4–6 years of related experience
- Bachelor's degree in Nursing preferred
- Pediatric experience preferred
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required or NP - Nurse Practitioner - Current State's Nurse Licensure required
- Resource Utilization Group (RUG) certification must be obtained within 90 days of hire (required for Superior)
- Candidate must live in/around San Antonio, TX
- Ability to perform home and/or other site visits as required
- Experience assessing and coordinating care for complex/high acuity populations
- Ability to collect, document, and maintain all member information and care management activities to ensure compliance with state, federal, and clinical guidelines
- Experience precepting, coaching, and supporting clinical new hires/preceptees
