Senior LTSS Service Care Manager (RN)

Summary:

• Work Mode: Remote - Texas
• Duration: 6 months with possible extension

Responsibilities:

• 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.
• 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.
• Ensure efficiency, quality, and compliance with timeliness of required assessments and documentation.
• Engage in process improvement to enhance overall performance concerns, improve member outcomes, and address UMR cases/audits.
• Assist with member tasks – follow up with members regarding coordination of care.
• Follow up with providers and doctors’ offices.

Requirements:

• Associate or bachelor’s degree in nursing.
• Registered Nurse licensure.
• Minimum 1 year of experience in Case Management or Home Health.
• Proficient in computer and phone skills.
• Self-motivated, organized, and able to prioritize tasks.
• Strong documentation skills and ability to follow policies and work processes.

Preferred Skills:

• 1+ years of experience in Case Management.
• MCO experience.
• Comprehensive clinical assessment skills and critical thinking.
• Detail-oriented, especially in documentation, timeliness, and compliance.
• Experience with Case Management and coordination.

Benefits:

• Allows flexibility to work remotely.
• Supportive team environment willing to assist and answer questions.