Care Manager RN - 401k, medical benefits, tuition reimbursement
Company: Superior HealthPlan
Location: Lubbock
Posted on: September 25, 2024
Job Description:
You could be the one who changes everything for our 28 million
members. Centene is transforming the health of our communities, one
person at a time. As a diversified, national organization, you'll
have access to competitive benefits including a fresh perspective
on workplace flexibility.
MUST BE LICENSED AND RESIDE IN THE STATE OF TEXASHybrid Position -
Field visits and work from homeService Area: San Angelo, Ballinger,
Brady, Bronte, Abilene and surrounding areaPosition Purpose:
Performs care management duties to assess and coordinate all
aspects of medical and supporting services across the continuum of
care for complex/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 on services and benefit options available
to receive appropriate high-quality care.
- Evaluates the service needs of the most complex 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 progress 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 develop
appropriate care plans / service plans
- Collaborates with healthcare providers as appropriate to
facilitate member services and/or treatments and determine a
revised care plan for member if needed
- Collects, documents, and maintains all member information and
care management activities to ensure compliance with current 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, healthcare provider instructions, care options, referrals,
and healthcare benefits
- Acts as liaison and member advocate 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 perform 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 onboarding process to upskill readiness
- May provide guidance and support to clinical new
hires/preceptees in navigating within a Managed Care Organization
(MCO) and provides coaching and shadowing opportunities to bridge
gap between classroom training and field practice
- May engage and assist New Hire/Preceptee during onboarding
journey including responsibility for completing competency check
points ensuring readiness for Service Coordination success
- 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 all policies and standardsEducation/Experience:
Requires Graduate from an Accredited School or Nursing or a
Bachelor's degree and 4-6 years of related experience
Bachelor's degree in Nursing preferred
License/Certification:
- RN - Registered Nurse - State Licensure and/or Compact State
Licensure required or
- NP - Nurse Practitioner - Current State's Nurse Licensure
required
- For Superior: Resource Utilization Group (RUG) certification
requiredPay Range: $34.81 - $62.54 per hourCentene offers a
comprehensive benefits package including: competitive pay, 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-related factors permitted by law. Total compensation
may also include additional forms of incentives.Centene is an equal
opportunity employer that is committed to diversity, and values the
ways in which we are different. All qualified applicants will
receive consideration for employment without regard to race, color,
religion, sex, sexual orientation, gender identity, national
origin, disability, veteran status, or other characteristic
protected by applicable law.
Keywords: Superior HealthPlan, Lubbock , Care Manager RN - 401k, medical benefits, tuition reimbursement, Executive , Lubbock, Texas
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