Clinical - Senior LTSS Service Care Manager RN
Clinical - Senior LTSS Service Care Manager RN
Posted on :
31-12-2024
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1 Vacancy
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Monthly Salary
Not Disclosed
Salary Not Disclosed
Vacancy
1 Vacancy
Posted on :
31-12-2024
Job Description
Title: Senior LTSS Service Care Manager (RN)
Location: Remote
Duration: 6months
Shift: Standard
Description:
- 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 longterm care members addresses issues and educates members and their families/caregivers on services and benefit options available to receive appropriate highquality care.
Education/Experience:
- Requires Graduate from an Accredited School or Nursing or a Bachelors degree and 4 6 years of related experience.
- Bachelors degree in Nursing preferred.
License/Certification:
- RN Registered Nurse State Licensure and/or Compact State Licensure required.
- NP Nurse Practitioner Current States Nurse Licensure required.
- For Superior: Resource Utilization Group (RUG) certification required.
Roles and 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 longterm care plans / service plans and collaborates with care management team to identify providers specialists and/or community resources needed to address members 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 personcentered 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 members goals / needs.
- Monitors member status for complications and clinical symptoms or other status changes including assessment 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 longterm 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 longterm care members in a costeffective 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.
Employment Type
Full Time
Key Skills
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