Senior LTSS Service Care Manager, RN

Role Overview

• 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
• Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team
• Monitors care plans/service plans and/or member status
• 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
• Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments
• Collects, documents, and maintains all member information and care management activities
• Provides and/or facilitates education to long-term care members and their families/caregivers
• Acts as liaison and member advocate between the member/family, physician, and facilities/agencies
• May perform home and/or other site visits to assess member needs and collaborate with resources
• 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 and provide guidance and support in navigating within a Managed Care Organization (MCO)

Requirements

• Graduate from an Accredited School of Nursing
• 4–6 years of related clinical nursing experience
• Bachelor's degree in Nursing preferred
• 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
• Clinical RN or Case Management experience in Nursing Facilities, LTC, SNF, Home Health, and/or Hospice settings
• Current or previous government-sponsored healthcare experience preferred
• Critical thinking skills and ability to use nursing judgement to assess member’s health risks to ensure member safety
• Strong clinical documentation and time management skills
• Flexibility, resilience, and excellent interpersonal communication skills for member advocacy
• Reliable transportation

Benefits

• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules