Senior LTSS Service Care Manager RN - Pediatrics Join to apply for the Senior LTSS Service Care Manager RN - Pediatrics role at Superior HealthPlan
Overview Centene is transforming the health of our communities. As a diversified national organization, you’ll have access to competitive benefits, including flexibility in the workplace. Must reside in the San Antonio, TX area. Pediatric experience required. Hybrid position with field visits and work from home.
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. 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.
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
Coordinates and manages between the member/family/caregivers and the care provider team to ensure person-centered care
Monitors care plans/service plans and changes in condition; revises care plans as necessary to meet member goals
Monitors member status for complications and clinical symptoms and assess for potential entry into higher level of care/waiver eligibility as applicable
Reviews member data to identify trends and improve operating performance and quality care
Reviews referrals and intake assessments to develop appropriate care plans
Collaborates with healthcare providers to facilitate services and revise care plans as needed
Collects, documents, and maintains all member information to ensure compliance with state/federal/clinical guidelines
Provides education to long-term care members and families on disease processes, resolving care gaps, treatment instructions, care options, referrals, and benefits
Acts as liaison and member advocate between member/family, physician, and facilities/agencies
Educates on and coordinates community resources; coordinates service authorization for services (e.g., meals, housing, transportation, daily living activities)
May perform home or site visits to assess needs and collaborate with resources
Partner with leadership to improve quality of care and service delivery in a cost-effective manner
May precept clinical new hires and support onboarding and skill development
Engage with People Leaders and cross-functional teams to measure readiness
Performs other duties as assigned and complies with all policies and standards
Education/Experience Requires 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 Resource Utilization Group (RUG) certification must be obtained within 90 days of hire
Pay and Benefits Pay Range: $35.49 - $63.79 per hour. Centene offers a comprehensive benefits package including health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements (remote, hybrid, field, or office).
Actual pay will be adjusted based on skills, experience, education, and other job-related factors, including full-time or part-time status. Total compensation may include additional incentives. Benefits subject to program eligibility.
Equal Opportunity Centene is an equal opportunity employer committed to diversity. 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 protected characteristics. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.