Acute Care, Auditing, Behavioral Health, Case Management, Clinical Competency, Clinical Monitoring, Clinical Outcomes, Clinical Practices/Protocols, Community Support, Community and Social Services, Computer Skills, Cross-Functional, Customer Support/Service, Documentation, Documentation Standards, Establish Priorities, Health Plan, Healthcare, Home Care, Leadership, Maintain Compliance, Managed Care, Medical Office, Medical Office Administration, Mentoring, Metrics, Needs Assessment, Nursing, Onboarding, Operating Room Nursing, Organizational Skills, Performance Management, Process Improvement, Quality Assurance, Quality Management, Registered Nurse (RN), Regulatory Compliance, Risk, Social Work, Treatment Plan, Trend Analysis, Utilization Management
Title: Senior LTSS Service Care Manager (RN)
Duration: 6 Months Possible Extensions & Conversion
Location: Remote
Schedule: Standard 1st shift, | Mon Fri | 40 hours week | Overtime: Possible
Pay Range: XXXXXXXXXXX - XXXXXXXXXXX Per hr. on w2.
Position Overview
Seeking a Senior LTSS Service Care Manager (RN) to support complex and high-acuity Long-Term Services and Supports (LTSS) members through comprehensive care management, service coordination, and clinical oversight.
This role is responsible for assessing member needs, developing individualized care plans, coordinating services across the continuum of care, collaborating with providers and caregivers, and ensuring compliance with regulatory and clinical standards. The Care Manager will advocate for members while promoting quality, cost-effective healthcare outcomes.
The ideal candidate will possess strong clinical assessment skills, case management experience, excellent documentation abilities, and the ability to work independently in a remote environment.
Project Overview
This position was created to support increased member volume and assist existing RN Care Managers with care coordination activities, documentation, compliance requirements, and member follow-up responsibilities.
The contractor will help:
- Support medical, behavioral health, and social support teams
- Conduct member outreach and follow-up
- Coordinate care with providers and caregivers
- Assist with assessments and care planning activities
- Improve turnaround times and compliance metrics
- Support quality initiatives and audit performance improvements
- Improve member outcomes through effective care management
This role serves as temporary project support while the team addresses increased case volume and workload demands.
Day-to-Day Responsibilities
Care Management & Member Support
- Assess service needs of complex and high-risk LTSS members
- Develop individualized care plans and service plans
- Coordinate medical, behavioral, and social services
- Conduct member outreach and follow-up activities
- Educate members and caregivers regarding healthcare benefits, services, and treatment plans
- Support members in accessing community resources and support services
- Monitor member progress toward care plan goals
Care Coordination
- Coordinate care among members, families, providers, specialists, and community resources
- Work closely with physicians, caregivers, and interdisciplinary care teams
- Review referrals and intake assessments
- Facilitate access to needed services and treatments
- Coordinate service authorizations and benefit-related services
Clinical Monitoring
- Monitor changes in member condition
- Identify potential complications and escalating care needs
- Evaluate eligibility for higher levels of care when applicable
- Support quality improvement initiatives and clinical outcomes
Documentation & Compliance
- Maintain timely and accurate documentation
- Complete assessments within required turnaround times
- Ensure compliance with state, federal, and clinical guidelines
- Monitor care management activities for quality and audit readiness
- Review member data and identify trends to improve outcomes
Provider & Community Collaboration
- Follow up with providers and physician offices
- Educate providers and community partners regarding available programs and services
- Act as liaison between members, families, physicians, and healthcare facilities
Team Support
- Participate in onboarding support and mentoring activities when needed
- Assist with knowledge sharing and process improvement initiatives
- Collaborate with leadership and cross-functional teams
Performance Expectations
- Manage assigned caseload of approximately 20 members per month
- Conduct weekly member follow-up activities
- Meet assessment and documentation timeliness standards
- Maintain compliance with care management requirements
- Improve quality, audit, and utilization management outcomes
- Support member satisfaction and health outcomes
Required Qualifications
Education
- Associate Degree in Nursing OR
- Bachelor's Degree in Nursing preferred
Licensure
- Active Registered Nurse (RN) License required
- Compact RN License accepted where applicable
Experience
- 1 2+ years of Case Management experience OR
- 1 2+ years of Home Health experience
Required Skills
- Comprehensive clinical assessment skills
- Strong critical thinking abilities
- Case management and care coordination experience
- Excellent documentation skills
- Strong organizational and prioritization abilities
- Computer proficiency
- Phone-based member engagement experience
- Ability to work independently in a remote environment
Preferred Qualifications
- Bachelor's Degree in Nursing
- Managed Care Organization (MCO) experience
- LTSS experience
- Care Management experience with high-acuity populations
- Experience working with community resources and social support services