Senior LTSS Service Care Manager (RN)

Position Title: Senior LTSS Service Care Manager (RN)

Work Location: Member Facing - Source from Hidalgo SDA, TX

Assignment Duration: 6 months Contract to Hire

Work Schedule: Monday - Friday, 8 AM to 5 PM. OT if needed, depending on business needs

Work Arrangement: 3 Days Home visits and 2 days work from home

Position Summary:

Assesses, plans, implements, and coordinates holistic care management activities to enable quality, cost. effective healthcare outcomes. May develop or assist with developing a personalized care plans/service plans for long?term care members and educates members and their families/caregivers on services and benefits available to meet member needs.

Background & Context:

* Provide support to medical, behavioral and social support staff to determine needs, eligibility and services for members.

* Conduct screening and risk assessment interventions per program guidelines. Job Responsibilities: Identify special needs members through the completion of health screens and other resources.

* Work with community outreach/member advocates to coordinate member care.

* Educate providers and community resources on program components and available support services. Educate members with special needs to foster compliance with program and positively impact outcomes.

* Assist with modification and management of care plans, medical consenter or caregiver, and family, if applicable, as well as the managing physician

* Efficiency, quality and compliance with timeliness of required assessments and documentation. Process improvement to improve overall performance concerns; Seeing improvement on UMR cases/audits, improve member outcomes.

Key Responsibilities:

* Assists with developing and continuously assessing ongoing long-term care plans and works to identify providers, specialists, and/or community resources needed for long-term care

* Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure identified services are accessible to members

* Monitors care plans/service plans, member status and outcomes, as appropriate, and provides recommendations to care plan/service plan based on identified member needs

* Identifies problems/barriers for long-term care management and appropriate care management interventions

* Provides resource support to members and their families/caregivers for various needs (e.g. employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans

* Reviews long?term care 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 assist with developing appropriate long? term care plans/service plans

* Collaborates with healthcare providers/partners as appropriate to facilitate member care to ensure member needs are met and determine a revised service plan/care plan for member if needed

* May perform home and/or other site visits to assess member's needs and collaborate with healthcare providers and partners

* Collects, documents, and maintains long?term care member information and care management activities to ensure compliance with current state, federal, and third?party payer regulators

* Provides and/or facilitates education to members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits

* Partners with leadership team to improve and enhance quality of care and service delivery for long?term members in a cost?effective manner

* Provides overall guidance and training to other team members within team

* May assist with additional assignments, projects or other support as needed

* Performs other duties as assigned.

* Complies with all policies and standards.

Qualification & Experience:

* Requires a Bachelor's degree and 4 - 6 years of related experience.

* Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

* License/Certification: Associate or bachelor's degree in nursing required; Registered Nurse required. Preferred: 1-2 yrs experience in Case Management or Home Health; Preferred: RN (1 year is ideal, but manager is willing to be flexible)

* Must haves: 1-2 yrs experience in Case Management or Home Health, Computer skills, phone skills

* Nice to haves: MCO experience

* Performance indicators: be self?motivated, organized, and able to prioritize tasks. Possess strong documentation skills and must be able to follow policies and work processes.