Clinical Senior LTSS Service Care Manager (RN) J01077

Job Title: Sr LTSS Service Care Manager RN

Location: Candidates must reside in TX - La Feria Harlingen San Benito

Duration: 6 months Temp to hire position

• Training Mon Fri 8am -5pm CST 8 weeks CAMERAS ON NO TIME OFF for first 4 months
• Mon Fri 8am 5pm CST; with possible OT required.
• May need to stay late if needed may need to work a weekend if available No holidays
• 4-7 visits per week to members homes will be aware in advance
• May need to accommodate to members schedules for home visits
• May need to travel up to 2 hours away

• 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 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 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 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 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 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

• Requires Graduate from an Accredited School of Nursing or a Bachelors degree and 4 6 years of related experience

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required

• 4 6 years of related experience case management private duty nursing pediatric population. Bilingual candidates are needed.

• Communication written and verbal
• Problem solving/Navigating complex challenges/independent work/troubleshooting skills a must
• Adaptability/Flexible (may need to accommodate to members schedules for home visits) reliable transportation