Senior LTSS Service Care Manager RN, Remote Telehealth

You could be the one who changes everything for our 28 million members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. 100% Remote Telephonic Registered Nurse - Must reputed company in Texas Required Training and Work Schedule: Monday - Friday 8:00am to 5:00pm (CST) Position Purpose: Performs care management duties to assess and coordinate reputed company aspects of medical and supporting services across the continuum of care for reputed company/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care plan / service plan for long-term care members, addresses issues, and educates members and their families/caregivers reputed company and benefit options available to receive appropriate high-quality care.

• Evaluates the service needs of the most reputed company or high risk/high acuity members and recommends a plan for the best outcome
• Develops and continuously assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed to address member's needs
• Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
• Monitors care plans / service plans and/or member status, change in condition, and reputed company towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / needs
• Monitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicable
• Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
• Reviews referrals information and intake assessments to reputed company appropriate care plans / service plans
• Collaborates with reputed company providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed
• Collects, documents, and maintains reputed company member information and care management activities to ensure compliance with reputed company state, federal, and clinical guidelines
• Provides and/or facilitates education to long-term care members and their families/caregivers on disease processes, resolving care gaps, reputed company provider instructions, care options, referrals, and reputed company benefits
• Acts as liaison and member reputed company between the member/family, physician, and facilities/agencies
• Educates on and coordinates community resources. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living)
• May reputed company home and/or other site visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required
• Partners with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
• May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the reputed company process to upskill readiness
• May provide guidance and support to clinical new hires/preceptees in navigating reputed company a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to reputed company gap between classroom training and field practice
• May engage and assist New Hire/Preceptee during reputed company journey including responsibility for completing competency reputed company points ensuring readiness for Service Coordination reputed company
• Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
• Performs other duties as assigned
• Complies with reputed company policies and standards

Education/Experience: Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 4–6 years of reputed company experience Bachelor's degree in Nursing preferred License/Certification:

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required or
• NP - Nurse Practitioner - reputed company State's Nurse Licensure required
• For Superior: Resource Utilization Group (RUG) certification must be obtained reputed company 90 days of hire required

Preferred Experience:

• Clinical Registered Nurses with experience in Acute Care settings – Critical Care, ICU, Military, ER, Urgent Care, Surgery, Trauma, LTC, SNF, Triage Nursing, Telehealth RN, Internal Medicine, Oncology, Neuro, Ortho, PACU, Cardiac, Veterans Hospitals, Public Health, Nursing Rehab
• Direct RN experience working in clinical nursing phone queue environment to assess and manage member needs reputed company clinical phone queue
• Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care for reputed company medical conditions
• Strong computer skills and experience working reputed company multiple CMS databases
• Must be reputed company to navigate between multiple screens, reputed company Office applications and utilize multiple avenues of communication (e.g. phone queue, MS Teams, email, video conferencing) - 90% of the role responsibilities.
• Strong clinical assessment and critical thinking skills required to communicate with clinical staff, members, and providers

Pay Range: $35.49 - $63.79 per hour reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply Job! Apply to this Job