Clinical - Senior LTSS Service Care Manager (RN)

Job Title: Senior LTSS Service Care Manager (RN)
Location: Remote Texas
Duration: 6 Months (Possible Extension)
Schedule: Monday Friday | Standard 1^st shift | 8 hours day 40 hours week | OT Possible
Pay Range: XXXXXXXXXXX - XXXXXXXXXXX/hour on w2.

Position Overview

• The Senior LTSS Service Care Manager (RN) is responsible for assessing, coordinating, and managing care for complex and high-acuity members with primary medical and physical health needs.
• This role focuses on developing and monitoring individualized long-term services and supports (LTSS) care plans, coordinating medical and community-based services, and promoting quality, cost-effective outcomes.
• The Care Manager will collaborate with members, families, caregivers, healthcare providers, and community resources to ensure members receive appropriate, person-centered care.
• This position also provides support to medical, behavioral health, and social support teams in determining member needs, eligibility, and available services.

Key Responsibilities

• Conduct comprehensive clinical assessments, health screenings, and risk assessments to identify members with complex or special healthcare needs.
• Evaluate the service needs of high-risk and high-acuity members and recommend appropriate care plans to achieve optimal outcomes.
• Develop, implement, and continuously monitor individualized long-term care and service plans.
• Coordinate care among members, families, caregivers, physicians, specialists, healthcare providers, and community resources.
• Follow up with members regularly to monitor their health status, care needs, and progress toward established care plan goals.
• Maintain weekly follow-ups with assigned members and coordinate necessary services and interventions.
• Contact healthcare providers and physicians' offices to obtain information, coordinate treatments, and address member care needs.
• Monitor changes in member conditions, identify potential complications, and assess the need for a higher level of care or additional services.
• Review referrals and intake assessments to determine appropriate care plans and service needs.
• Educate members, families, and caregivers on disease processes, healthcare benefits, available services, care options, and provider instructions.
• Coordinate community-based resources and services, including transportation, housing, meals, employment support, and activities of daily living.
• Assist with modifications and ongoing management of care plans in collaboration with members, caregivers, families, medical consenters, and managing physicians, as applicable.
• Review member information and clinical data to identify trends and support improved quality of care and operational performance.
• Maintain accurate and timely documentation of assessments, care plans, member interactions, and care management activities in accordance with state and federal regulations.
• Act as a liaison and advocate between members, families, physicians, healthcare providers, and community agencies.
• Support quality improvement initiatives, process improvements, and compliance with required assessment and documentation timelines.
• Perform other duties as assigned and comply with all organizational policies and standards.

Education and Qualifications

Required:

• Associate or Bachelor's degree in Nursing from an accredited institution.
• Active Registered Nurse (RN) license in Texas or a Compact State.
• 1 2 years of experience in Case Management or Home Health.
• Strong clinical assessment, critical thinking, and care coordination skills.
• Excellent computer skills and proficiency in using healthcare documentation systems.
• Strong telephone communication and member/provider follow-up skills.
• Ability to maintain accurate documentation and meet required deadlines.

Preferred:

• Bachelor's degree in Nursing (BSN).
• 1 2 years of Case Management experience.
• Experience working with a Managed Care Organization (MCO).
• Previous experience supporting Long-Term Services and Supports (LTSS) populations.

Required Skills

• Comprehensive Clinical Assessments
• Clinical Judgment and Critical Thinking
• Long-Term Services and Supports (LTSS)
• Case Management and Care Coordination
• Home Health Experience
• Individualized Care Plan Development
• Member and Provider Communication
• Clinical Documentation and Compliance
• Healthcare Benefits and Service Coordination
• Microsoft Office and Computer Skills
• Time Management and Prioritization

Workload and Performance Expectations

• Manage an assigned monthly caseload of up to approximately 20 members.
• Conduct weekly follow-ups with assigned members.
• Coordinate with physicians, providers, and community resources to address member needs.
• Complete assessments and documentation accurately and within required timelines.
• Maintain compliance with established policies, procedures, and program guidelines.
• Demonstrate strong organization, accountability, and the ability to manage competing priorities.

Ideal Candidate Profile

• The ideal candidate is a self-motivated and detail-oriented Registered Nurse with experience in case management, home health, or care coordination.
• The candidate should demonstrate strong clinical assessment and critical thinking abilities, excellent documentation practices, and the ability to independently manage member follow-ups in a remote work environment.

Interview and Selection Process

• Interview Format: Microsoft Teams
• Candidate Review: Approximately 2 4 business days after shortlisting
• Assessment: Basic computer skills test

Additional Information

• Remote position; candidates must reside in Texas.
• Overtime may be required based on business needs.
• A clinical license verification is required.