Regional Asset Protection Manager
BJ's Wholesale Club
Manager, LTSS Clinical Care Management, RN
Centene Corporation
full-time
Posted on:
Location Type: Hybrid
Location: Austin • Texas • 🇺🇸 United States
Visit company websiteSalary
💰 $100,900 - $186,800 per year
Job Level
Mid-LevelSenior
About the role
- Manages the RN care management team of licensed physical and/or behavioral health clinicians that serve long-term care members with physical/medical health needs and/or behavioral/mental health needs to develop and assess high quality, cost-effective healthcare outcomes.
- Manages escalations and care management issues related to members or providers.
- Oversees and reviews long-term care management required documentation to maintain compliance with federal and state regulations and contractual agreements.
- Develops, implements, and oversees long-term care management policies and procedures within the long-term care management team based on regulatory requirements and industry standards.
- Assigns, monitors and evaluates work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs.
- Directs the daily activities of long-term care management staff including reviewing and approving the caseloads based on state requirements, care management staff experience, and member needs.
- Manages escalated and complex care cases, and provides guidance to long-term care team members to address member concerns related to physical/medical health and/or mental/behavioral health needs.
- May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources.
- Ensures proper coordination and communication of medical service functions with other departmental functions at the business as assigned.
- Develops, implements, and oversees long-term care management programs to facilitate the use of appropriate services and resources.
- Sets goals and objectives for long-term care management team to achieve cost-effective healthcare results.
- Monitors audits within care management to ensure compliance with regulatory requirements for federal, state, and NCQA standards, as required.
- Reviews long-term care member data to identify trends and improve operating performance and quality care.
- Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care.
- Educates and provides resources for long-term care management team on key initiatives and member outreach.
- Assists long-term care management senior leadership with onboarding, hiring, and training long-term care management team members.
- Leads and champions change within scope of responsibility.
- Performs other duties as assigned.
- Complies with all policies and standards.
Requirements
- Graduate from an Accredited School of Nursing or a Bachelor's degree and 5+ years of related experience, or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
- Positions overseeing RN and BH team members: Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 5+ years of related experience
- Current state's Registered Nurse (RN) license is required
- For Superior: Resource Utilization Group (RUG) certification must be obtained within 90 days of hire and must be RUG certified if overseeing RN team members
- Applicants must reside in the Austin or San Antonio, TX area to supervise field visits
- Preferred: 3+ years RN Clinical Supervisor, RN Manager, or ADON experience preferred
- Preferred: Advanced clinical knowledge and ability to assess member needs in context of relevant diagnoses, treatment plans and goals
- Preferred: Strong knowledge of managed care principles
- Preferred: Experience working with providers and healthcare teams to develop appropriate long-term service plans/care plans
- Preferred: Strong knowledge of medication indications and side effects and/or knowledge of RN or BH care management principles
- Ability to perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
- Experience with audits, regulatory compliance (federal, state, NCQA)
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
- Total compensation may also include additional forms of incentives
- Benefits may be subject to program eligibility
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
care managementclinical supervisionregulatory complianceauditingresource utilizationlong-term care managementmember assessmenttreatment planningmanaged care principlesmedication knowledge
Soft skills
leadershipcoachingcommunicationproblem-solvingteam managementgoal settingchange managementcollaborationorganizational skillsinterpersonal skills
Certifications
Registered Nurse (RN) licenseResource Utilization Group (RUG) certification
