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Senior LTSS Service Care Manager
Centene Corporation. Performs care management duties for complex/high-acuity populations with primary medical/physical health needs .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in care management for complex populations, developing personalized care plans, and collaborating with healthcare providers to optimize member outcomes. Proficient in clinical documentation, problem-solving, and resource coordination to enhance service delivery and quality of care.
Highest-signal resume keywords
RN State LicensureClinical DocumentationCare CoordinationResource Utilization Group CertificationClinical Nursing Experience
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 ManagementPersonalized Care PlansAssessment of Service NeedsMonitoring Member StatusDocumentation of Care ActivitiesCollaboration with Healthcare ProvidersHome VisitsQuality ImprovementCare Gap EducationService Authorization Coordination
Soft Skills
Problem-SolvingCommunicationAttention to DetailOrganizationFlexibility
Certifications & Qualifications
Resource Utilization Group CertificationRN State LicensureNP Current State's Nurse Licensure
Industry Keywords
Care CoordinationLong-Term CareInpatient to Home Care TransitionsAssisted LivingHome HealthHospiceSkilled Nursing FacilitiesClinical NursingMember AdvocacyCommunity Resources
About the role
Key responsibilities & impact- Performs care management duties for complex/high-acuity populations with primary medical/physical health needs
- Develops personalized care plans/service plans for long-term care members
- Assesses service needs and recommends plans for optimal outcomes
- Continuously assesses care plans and collaborates with care management teams, providers, specialists, and community resources
- Coordinates care between members/families/caregivers and provider teams
- Monitors member status, complications, symptoms, care-plan progress, and need for higher levels of care or waiver eligibility
- Reviews member data, referrals, and intake assessments to improve quality and operating performance
- Collaborates with healthcare providers to facilitate services and treatments
- Collects, documents, and maintains member information and care management activities
- Educates members and families/caregivers on disease processes, care gaps, provider instructions, care options, referrals, and benefits
- Acts as liaison and member advocate between members/families, physicians, and facilities/agencies
- Coordinates community resources and service authorizations, including meals, employment, housing, foster care, transportation, and activities of daily living
- Conducts home and other site visits to assess member needs and collaborate with resources
- Partners with leadership to improve quality, service delivery, and cost effectiveness
- May precept and coach clinical new hires/preceptees and support onboarding and competency readiness
- Performs other duties as assigned and complies 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 State Licensure and/or Compact State Licensure, or NP Current State's Nurse Licensure
- Resource Utilization Group (RUG) certification required within 90 days of hire for Superior
- Strong clinical documentation, problem-solving, communication, attention to detail, organization/time management skills
- Ability to work under quick TAT times and deadlines
- Ability to adapt to changing business needs with openness, flexibility, and professionalism
- Bachelor's degree in nursing (BSN) preferred
- 7+ years of clinical RN Case Management or Care Coordination preferred, with adult members needing transitions from inpatient to home care, assisted living, home health, hospice, long-term care, or skilled nursing facilities
Benefits
Comp & perks- Health insurance
- 401K plan
- Stock purchase plan
- Tuition reimbursement
- Paid time off
- Paid holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Mileage reimbursement for member visits
- Potential additional incentives