Hybrid Manager, LTSS Clinical Care Management, RN

at Centene Corporation

• Job title: Manager, LTSS Clinical Care Management, RN
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $100,900 - $186,800 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Austin, United States

About the role

• Manager of RN care management teams for Centene serving members with physical and mental health needs. Overseeing documentation compliance and developing care management programs and policies.

Responsibilities

• Manages the RN care management team of licensed physical and/or behavioral health clinicians that serve long-term care members with physical/medical health needs and/or behavioral/mental health needs to develop and assess high quality, cost-effective healthcare outcomes
• Manages escalations and care management issues related to members or providers
• Oversees and reviews long-term care management required documentation to maintain compliance with federal and state regulations and contractual agreements
• Develops, implements, and oversees long-term care management policies and procedures within the long-term care management team based on regulatory requirements and industry standards
• Assigns, monitors and evaluates work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs
• Directs the daily activities of long-term care management staff including reviewing and approving the caseloads based on state requirements, care management staff experience, and member needs
• Manages escalated and complex care cases, and provides guidance to long-term care team members to address member concerns related to physical/medical health and/or mental/behavioral health needs
• May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
• Ensures proper coordination and communication of medical service functions with other departmental functions at the business as assigned
• Sets goals and objectives for long-term care management team to achieve cost-effective healthcare results
• Monitors audits within care management to ensure compliance with regulatory requirements for federal, state, and National Committee for Quality Assurance (NCQA) standards, as required
• Works with long-term care management senior management to provide updates and insights on care management team goals
• Reviews long-term care member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
• Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care
• Educates and provides resources for long-term care management team on key initiatives and member outreach to facilitate on-going communication between care management team, members, and providers
• Assists long-term care management senior leadership with onboarding, hiring, and training long-term care management team members
• Leads and champions change within scope of responsibility
• Performs other duties as assigned
• Complies with all policies and standards

Requirements

• Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 5+ years of related experience, or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position
• 3+ years RN Clinical Supervisor, RN Manager, or ADON experience preferred
• Advanced clinical knowledge and ability to assess member needs in context of relevant diagnoses, treatment plans and goals, and identify potential gaps in care or risks for readmission or complications preferred
• Strong knowledge of managed care principles preferred
• Experience working with providers and healthcare teams to develop appropriate long-term service plans/care plans preferred
• Strong knowledge of medication indications and side effects and/or knowledge of RN or BH care management principles preferred
• Current state's Registered Nurse (RN) license is required
• Resource Utilization Group (RUG) certification must be obtained within 90 days of hire. Must be RUG certified if overseeing RN team members

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules