Senior LTSS Service Care Manager, RN

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

📋 Description

• Evaluate and coordinate medical and ancillary services throughout the care continuum for complex or high-acuity populations.

• Create individualized care and service plans for members requiring long-term care.

• Assess the service requirements of high-risk or complex members and recommend strategies for achieving the best outcomes.

• Regularly review long-term care plans and work with care management teams to identify appropriate providers, specialists, and community resources.

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

• Track care plans, monitor member status, observe changes in conditions, complications, clinical symptoms, and progress toward established goals.

• Modify and update care plans as necessary.

• Evaluate the need for potential transitions to higher levels of care and/or assess waiver eligibility.

• Analyze member data, referrals, and intake assessments to enhance quality and formulate suitable care plans.

• Collaborate with healthcare providers to streamline services, treatments, and updated care plans.

• Accumulate, document, and preserve member information and care management activities in accordance with state, federal, and clinical regulations.

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

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

• Organize community resources and service authorizations for essential services such as meals, employment, housing, foster care, transportation, and activities of daily living.

• May perform home visits or other site assessments to evaluate member needs and collaborate with available resources.

• Work alongside leadership to enhance quality of care and deliver cost-effective services.

• May mentor new clinical hires and assist with onboarding, competency evaluations, coaching, and readiness assessments.

⛳️ Requirements

• Graduation from an Accredited School of Nursing or a Bachelor's degree accompanied by 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 nurse licensure is required.

• For Superior: Resource Utilization Group (RUG) certification must be acquired within 90 days of employment.

• For Arkansas Total Care plan: a valid driver's license is required.

• For Arkansas Total Care plan: child and adult maltreatment checks must be completed prior to hiring and on a recurring basis.

• For Arkansas Total Care plan: a drug screening is required at the time of hire and on a recurring basis.

• For Arkansas Total Care plan: candidates must reside in Arkansas or a bordering city.

• Travel: 5% is required.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off in addition to holidays.

• Flexible options for remote, hybrid, field, or office work schedules.

• Additional forms of incentives may be included in total compensation.

• We are a diversity and equal opportunity employer.