Lead LTSS Service Care Manager (RN) (centene)

Job Description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Team Lead - Pediatric LTSS Service Care Manager, RN

Pediatric RN experience is required

LOCATION: San Antonio/Bexar County, TX.

Travel is required for clinical staff/member visits, leadership meetings, and training.

Position Purpose: Oversees the long-term care plans / service plans and care management activities to enable quality, cost effective healthcare outcomes. Reviews and provides expert knowledge to inform personalized care plans / service plans as appropriate/required for long-term care members and provides guidance and/or support to the care management team.

• Oversees and reviews ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed for long-term care
• Provides insight and guidance on developing care plans / service plans and triaging issues to appropriate healthcare providers for complex care plans / service plans
• Provides guidance and expert knowledge as appropriate to team members to ensure quality control over work, members are receiving needed care or services, and adherence to contract policies and procedures
• Monitors complex care plans / service plans and/or member status and outcomes or changes in condition, and revises care plan / service plan based on member needs and issues identified
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• Partners and collaborates with healthcare providers as appropriate to facilitate member's treatments to ensure member service / care needs are met and determine a revised care plan / service plan for member if needed
• Provides subject matter expertise insights for complex long-term care plans / service plans based on prior experience to recommend enhanced member care within the care management plan
• Works with senior management on escalated and complex care cases, and provides guidance to junior team members to address member concerns
• May perform home and/or other site visits to assess member’s needs and collaborate with healthcare providers and partners
• Reviews member data to identify health risks and/or care gaps, partner and collaborate with providers / specialists as appropriate to facilitate member’s services and address member’s needs/issues
• Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines
• Works as a subject matter expert (SME) and provides training and education to care management team and/or providers to ensure members are receiving high quality care and information regarding treatment plan options, procedures, referrals, and healthcare benefits
• Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 5 – 7 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 Licensure required

• For Superior: Resource Utilization Group (RUG) certification must be obtained within 90 days of hire required

Preferred Experience:

• Clinical RN nursing experience with direct pediatric patient care and/or administering medically approved Medicaid Health assessments

• Case Management and Care Coordination

• Coordinating referral services for complex medical conditions

• Pediatrics General Medicine, NICU, PICU, Pediatric ER experience

• Pediatric Home Health or Private Duty Nursing

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.  Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act