Clinical - Senior LTSS Service Care Manager (RN)

Location: 80% member facing source from Lubbock, TX

Visits:

• Visits are completed in the home setting, travel to members’ home is necessary.
• Travelling may be 100 mile radius.
  • Visits may include surrounding counties
  • Visits are typically M-F 8-5; Due to the pediatric population, some visits are at 3pm or after, we occasionally receive requests for Saturday which may be assigned on a round robin basis if no volunteers are available.

Traveling:
Shift: Mon - Fri 8 am – 5pm, may require after hour visits as per member request

Job Description:

• Complete in-home assessment which includes:
  • SAI Core A to Core Q
  • ISP
  • EDP
  • Other forms as applicable: 1500 forms, SBP, EVV
  • 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 5 successful visits per week
  • Submit assessment within 24 hours of visit
  • Submit all other documentation within 5 Client
• Visits are typically M-F 8-5; however, due to contractual requirements, assessments and documentation do require to be turned in within turnaround times/compliance
• Due to the pediatric population, some visits are at 3pm or after, we occasionally receive requests for Saturday which may be assigned on a round robin basis if no volunteers are available.
• Visits are completed in the home setting, travel to members’ home is necessary.
• Travelling may be 100 mile radius.
  • Visits may include surrounding counties
  • Travel time will be taken into consideration and may modify productivity for that week.

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.

Education/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 client: Resource Utilization Group (RUG) certification required at time of hire.Required Skills/Experience: Preferred Skills/ Experience: 1.Registered Nurse 1.Bilingual 2.Pediatric Experience2.Case Management3. 3. Education Requirement:ADN or BSNEducation Preferred:Bachelor of Science in NursingRequired Certifications:Registered NurseIs DFPS check required? NoRequired Testing: Software Skills Required:Important to demonstrate resilience when it comes to computer skills, Excel