Clinical - Senior LTSS Service Care Manager (RN)

Location : This is a Remote / Member facing position where % of the time the contractor will be visiting members in their homes or facilities in The following counties : Hockley, Lubbock, Crosby, Terry, Lynn, Garza, Lamb, Hale, and Floyd

Travelling may be + mile radius. Preferred counties are : Hockley, Lubbock, Crosby, Terry, Lynn, Garza, Lamb, Hale, and Floyd Visits will be within the Lubbock Service Delivery Area which includes counties from Hutchinson to Terry, Lynn, and Garza Visits may include surrounding counties : Potter, Carson, Deaf Smith and Randall

Shift : am to pm, may require after hour visits as per member request

Duration : Month CONTRACT ONLY. There will be No FTE conversion available at this time

Job Description : Position 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.

Walk me through the day-to-day responsibilities of this the role and a description of the project :

• Assessing the member’s current health status, resource utilization, past and present treatment plan and services, short- and long-term goals, treatment and provider options.
• Follow up on requests for items / services
• Speaking to providers

Describe the performance expectations / metrics for this individual and their team :

• Complete successful visits per week Submit assessment within hours of visit Submit all other documentation within Client
• Visits are typically M-F -; however, due to contractual requirements, assessments and documentation do require to be turned in within turnaround times / compliance
• Due to pediatric population some visits are pm or after, we get request for Saturday visits at times
• Visits are completed in the home setting, travel to members home is necessary.
• Travelling may be + mile radius. Preferred counties are : Hockley, Lubbock, Crosby, Terry, Lynn, Garza, Lamb, Hale, and Floyd Visits will be within the Lubbock Service Delivery Area which includes counties from Hutchinson to Terry, Lynn, and Garza Visits may include surrounding counties Travel time will be taken into consideration and may modify productivity for that week.

Education / Experience :

Requires Graduate from an Accredited School or Nursing or a Bachelor's degree and 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

Resource Utilization Group (RUG) certification required at the time of hire.

Job Duties :

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 (, meals, employment, housing, foster care, transportation, activities for daily living)

May perform home and / or other site visits (, once a month or more), such as to assess member needs and collaborate with resources, as required Required Skills / Experience : Preferred Skills / Experience : .

Registered Nurse . Bilingual . Pediatric Experience . Case Management . . Education Requirement : ADN or BSN Education Preferred : Bachelor of Science in Nursing Software Skills Required : Required Certifications : Registered Nurse Required Testing :