Position Purpose: Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care.
Key Details: This Senior Care Manager RN role supports members with physical health conditions, preventive care needs, and chronic disease management, such as asthma, diabetes, hypertension, high cholesterol, respiratory illnesses, or stress-related conditions. Knowledge and experience working with state-government sponsored programs (Medicaid, STAR CHIP) a PLUS. The standard schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m.(CST)
- Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member's unmet 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 / unmet needs
- May identify problems/barriers for care management and appropriate care management interventions for escalated cases
- 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
- May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
- 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 third-party payer regulators
- Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
- Partners with leadership team to improve and enhance care and quality delivery for 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
- Provides 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
- Engages and assists 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
- Other duties or responsibilities as assigned by people leader to meet business needs
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience: Requires a Degree from an Accredited School or Nursing or a Bachelor's degree in Nursing and 4 – 6 years of related experience.
Preferred Experience
- 7+ years of clinical nursing RN experience with direct patient care, clinical assessment, person-centered care planning, member outreach, care transitions, access to care, family & patient education, and ongoing service coordination for members (ages: 0- 65), but primarily with the adult population.
- Strong clinical documentation, problem-solving, communication, attention to detail, organization/time management skills, and works well under quick TAT times and deadlines are required.
- Ability to adapt to changing business needs with openness, flexibility, and professionalism.
License/Certification
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Pay Range: $75,300.00 - $135,400.00 per year