Senior LTSS Service Care Manager (RN)

Position Title: Senior LTSS Service Care Manager (RN)

Work Location: El Paso Texas

Assignment Duration: 5+ months (Possibility to extend or convert)

Work Schedule: 8 am - 5pm, may require after hour visits as per member request

Work Arrangement: Remote (Member facing)

Position Summary:

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 with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care plan / service plan for long-term care members, addresses issues, and educates members and their families/caregivers on services and benefit options available to receive appropriate high-quality care.

Background & Context:

• Health plan or business unit
• Team culture
• Surrounding team & key projects
• Purpose of this team
• Reason for the request
• Motivators for this need
• Any additional upcoming hiring needs?

Key Responsibilities:

• 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; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / needs
• Monitors member status for complications and clinical symptoms or other status changes, includingassessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicable
• 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 (e.g., meals, employment, housing, foster care, transportation, activities for daily living)
• May perform home and/or other site visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required
• 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, and guiding through the onboarding process to upskill readiness
• May provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice
• May engage and assist New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
• 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
• Complete in-home assessment which includes:
• SAI Core A to Core Q
• ISP
• EDP
• Other forms as applicable: 1500 forms, SBP, EVV
• Assessing the member's current health status, resource utilization, past and present treatment plan and services, short- and long-term goals, treatment and provider options.
• Follow up on requests for items/services
• Speaking to providers

Qualification & Experience:

• Requires Graduate from an Accredited School or Nursing or a Bachelor's degree and 4-6 years of related experience
• Bachelor's degree in Nursing 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 required
• Required ADN or BSN
• Required: RN
• Must haves:
• Nice to haves: Case Management,
• Disqualifiers:
• Performance indicators:
• 1 Registered Nurse, 4+ years of RN experience required
• 2 Pediatric Experience
• 3 Bilingual