Senior LTSS Service Care Manager RN
Superior HealthPlan
Position Purpose
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.
Responsibilities
Evaluate service needs of the most complex or high risk/high acuity members and recommend a plan for the best outcome.
Develop and continuously assess ongoing long‑term care plans and collaborate with the care management team to identify providers, specialists, and community resources needed to address member’s needs.
Coordinate and manage communication between the member (or family/caregivers) and the care provider team to ensure members receive appropriate person‑centered care.
Monitor care plans and member status, including changes in condition and progress toward goals; collaborate with member, caregivers, and providers to revise or update the plan as necessary.
Monitor member status for complications and clinical symptoms or other status changes, including assessment for potential entry into a higher level of care or waiver eligibility.
Review member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations.
Conduct intake assessments to develop appropriate care plans.
Collaborate with health care providers to facilitate member services and/or treatments and determine revised care plans when needed.
Document and maintain all member information and care management activities to ensure compliance with current guideline.
Provide education to long‑term care members and their families/caregivers on disease processes, care options, referrals, and benefits.
Act as liaison and advocate between the member/family, physician, and facilities/agencies.
Coordinate community resources and service authorizations (e.g., meals, housing, transportation).
Perform home or other site visits as required to assess member needs.
Partner with leadership to improve and enhance quality of care and service delivery for long‑term care members.
Precept clinical new hires by coaching and providing hands‑on training to bridge classroom and field practice.
Engage in ongoing collaboration with People Leaders and cross‑functional teams to monitor readiness.
Perform other duties as assigned.
Comply with all policies and standards.
Education & Experience
Requires a graduate from an accredited school of nursing or a bachelor’s degree and 4–6 years of related experience. Bachelor’s degree in nursing preferred.
License / Certification
RN – Registered Nurse – State Licensure or Compact State Licensure required.
NP – Nurse Practitioner – Current state nurse licensure required.
Resource Utilization Group (RUG) certification – must be obtained within 90 days of hire.
Pay
Pay range: $35.49 – $63.79 per hour.
Benefits
Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) 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.
Equal Opportunity Employer
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.