Senior LTSS Service Care Manager, RN

This is a fully remote position, open to applicants in New York.

📋 Description

• Execute care management responsibilities to evaluate and coordinate medical and ancillary services throughout the care continuum for complex/high-acuity populations.

• Create tailored care/service plans for long-term care members.

• Perform UAS Assessments for the MLTC member population associated with Fidelis.

• Assess the service needs of complex or high-risk/high-acuity members and propose care plans accordingly.

• Collaborate with care management teams to pinpoint providers, specialists, and community resources.

• Facilitate communication among members, families, caregivers, and care provider teams to ensure suitable person-centered care.

• Oversee care plans, member status, changes in condition, complications, symptoms, and progress towards established goals.

• Analyze member data, referrals, and intake assessments to enhance care quality and operational performance.

• Work alongside healthcare providers to streamline services and treatments while updating care plans as needed.

• Gather, document, and preserve member information and records of care management activities.

• Provide education to members and families/caregivers regarding disease processes, care gaps, provider instructions, care options, referrals, benefits, and community resources.

• Serve as a liaison and advocate for members among families, physicians, facilities, and agencies.

• Manage service authorizations for various services including meals, employment, housing, foster care, transportation, and activities of daily living.

• May perform home and other site visits, potentially on a monthly basis or more frequently, to assess member needs and coordinate resources.

• Collaborate with leadership to enhance the quality of care and ensure cost-effective service delivery.

• May mentor new clinical hires and provide coaching, shadowing, onboarding, and competency support.

• Engage with People Leaders and cross-functional teams to evaluate the readiness of new hires.

• Undertake other assigned responsibilities and adhere to policies and standards.

⛳️ Requirements

• Graduate from an Accredited School of Nursing or possess a Bachelor's degree with 4–6 years of relevant experience.

• A Bachelor's degree in Nursing is preferred.

• RN - Registered Nurse - State Licensure and/or Compact State Licensure is required, or NP - Nurse Practitioner - Current State's Nurse Licensure is required.

• Residency in Schuyler/Steuben/Livingston/Alleghany counties is mandatory.

• NY RN Licensure is necessary for eligibility.

• Capability to carry out UAS Assessments.

• Familiarity with long-term care, managed care, service plans, healthcare benefits, community resources, and relevant state and federal regulations.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off along with holidays.

• Flexible working arrangements including remote, hybrid, field, or office schedules.

• Additional incentive programs may be included in the overall compensation package.

• An equal opportunity employer dedicated to fostering diversity.