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Senior LTSS Service Care Manager, RN
Centene Corporation. Perform 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 and high-acuity populations, including the development and coordination of personalized care plans. Proficient in assessing member needs, monitoring progress, and collaborating with healthcare providers to ensure effective service delivery.
Highest-signal resume keywords
Registered Nurse (RN) LicensureCare Management for Complex PopulationsLong-Term Care PlansResource Utilization Group (RUG) CertificationIn-Person Assessments
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 DevelopmentMember Needs AssessmentService CoordinationClinical DocumentationMonitoring Member Status
Soft Skills
CollaborationEducation and AdvocacyCommunication
Certifications & Qualifications
Registered Nurse (RN) LicensureResource Utilization Group (RUG) Certification
Industry Keywords
High-Acuity PopulationsCommunity ResourcesService AuthorizationsHealthcare ProvidersClinical Guidelines
About the role
Key responsibilities & impact- Perform care management duties for complex/high-acuity populations with primary medical/physical health needs
- Assess and coordinate medical and supporting services across the continuum of care
- Develop personalized care plans/service plans for long-term care members
- Evaluate complex or high-risk members' service needs and recommend outcome-focused plans
- Continuously assess care plans and collaborate with care management teams to identify providers, specialists, and community resources
- Coordinate between members/families/caregivers and care provider teams to ensure person-centered care
- Monitor care plans, member status, changes in condition, complications, clinical symptoms, and progress toward goals
- Review member data, referrals, and intake assessments to improve quality and operating performance
- Collaborate with healthcare providers to facilitate services and treatments and revise care plans
- Collect, document, and maintain member information and care management activities
- Educate members and families/caregivers on disease processes, care gaps, provider instructions, care options, referrals, and benefits
- Act as liaison and member advocate between members/families, physicians, and facilities/agencies
- Coordinate community resources and service authorizations, including meals, employment, housing, foster care, transportation, and activities of daily living
- Perform home and other site visits, potentially once a month or more, to assess needs and collaborate with resources
- Partner with leadership to improve quality and cost-effective service delivery
- May precept and coach clinical new hires, support onboarding, complete competency checkpoints, and monitor readiness
- Perform other assigned duties and comply with policies and standards
Requirements
What you’ll need- Graduate from an Accredited School of Nursing or a Bachelor's degree and 4–6 years of related experience
- Bachelor's degree in Nursing preferred
- RN — Registered Nurse — state licensure and/or compact state licensure required, or NP — Nurse Practitioner — current state nurse licensure required
- Resource Utilization Group (RUG) certification must be obtained within 90 days of hire
- Experience with care management for complex/high-acuity populations
- Knowledge of long-term care plans/service plans, healthcare providers, specialists, and community resources
- Ability to assess member needs, coordinate services, monitor member status, and revise care plans
- Ability to document and maintain member information in compliance with state, federal, and clinical guidelines
- Ability to educate members and families/caregivers about disease processes, care options, referrals, and healthcare benefits
- Ability to coordinate service authorizations and community resources
- Ability to perform in-person assessments and home/other site visits
- Ability to comply with applicable policies, standards, and regulations
Benefits
Comp & perks- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off
- Paid holidays
- Flexible approach to work with remote, hybrid, field, or office work schedules
- Additional forms of incentives may be included in total compensation
- Equal opportunity and diversity commitment