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Senior LTSS Service Care Manager
Centene Corporation. Assess and coordinate medical and supporting services across the continuum of care for complex/high-acuity populations .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical nursing and care coordination, focusing on developing personalized care plans and optimizing outcomes for complex populations. Proficient in clinical documentation, member advocacy, and compliance with healthcare regulations.
Highest-signal resume keywords
RN - Registered Nurse - State LicensureClinical Nursing ExperienceCare CoordinationResource Utilization Group (RUG) CertificationClinical Documentation
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Care Plan DevelopmentClinical AssessmentService Authorization CoordinationData Review and AnalysisTransition of Care ManagementHome Health CoordinationLong-Term Care PlanningPatient EducationComplications MonitoringQuality Improvement
Soft Skills
Problem-SolvingCommunicationAttention to DetailOrganizationFlexibility
Certifications & Qualifications
RN - Registered Nurse - State LicensureNP - Nurse Practitioner - Current State's Nurse LicensureResource Utilization Group (RUG) Certification
Industry Keywords
Care ManagementClinical GuidelinesHealthcare ProvidersCommunity ResourcesMember AdvocacyInpatient to Home Care TransitionAssisted LivingSkilled Nursing FacilitiesHospice CareLong-Term Care
About the role
Key responsibilities & impact- Assess and coordinate medical and supporting services across the continuum of care for complex/high-acuity populations
- Develop personalized care plans and long-term care/service plans
- Evaluate service needs and recommend plans for optimal outcomes
- Collaborate with care management teams, healthcare providers, specialists, community resources, members, families, and caregivers
- Coordinate member services, treatments, service authorizations, referrals, and transitions of care
- Monitor care plans, member status, complications, clinical symptoms, and progress toward goals
- Review member data, referrals, and intake assessments to improve care quality and operating performance
- Document and maintain member information and care management activities in compliance with state, federal, and clinical guidelines
- Educate members and families/caregivers on disease processes, care gaps, care options, referrals, benefits, and community resources
- Act as liaison and member advocate between members/families, physicians, facilities, and agencies
- Conduct home and other site visits to assess member needs and coordinate resources
- Partner with leadership to improve quality and cost-effective service delivery
- May precept and coach clinical new hires, support onboarding, and assess competency readiness
- Perform other assigned duties and comply with policies and standards
Requirements
What you’ll need- Graduate from an Accredited School of Nursing
- 4–6 years of related clinical nursing experience
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required, or NP - Nurse Practitioner - Current State's Nurse Licensure
- Resource Utilization Group (RUG) certification must be obtained within 90 days of hire for Superior
- Strong clinical documentation, problem-solving, communication, attention to detail, and organization/time management skills
- Ability to work well under quick TAT times and deadlines
- Ability to adapt to changing business needs with openness, flexibility, and professionalism
- 7+ years of clinical RN Case Management or Care Coordination with adult members needing Transition of Care from Inpatient to Home Care, Assisted Living, Home Health, Hospice, Long-Term Care, Skilled Nursing facilities is preferred
- Bachelor's degree in nursing (BSN) is preferred
Benefits
Comp & perks- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Mileage reimbursement for member visits