Clinical - Senior LTSS Service Care Manager; RN - J01077

Position Purpose

For use by Arizona, Superior, and Sunflower only. 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.

• 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

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required
• NP - Nurse Practitioner - Current State's Nurse Licensure required
• For Superior:
  Resource Utilization Group (RUG) certification required

• Evaluates the service needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome
• Develops and assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and community resources
• Coordinates between the member and/or family/caregivers and the care provider team to ensure person-centered care
• Monitors care plans and member status, revising plans as necessary to meet goals/needs
• Monitors complications and status changes, including eligibility for higher levels of care or waivers
• Reviews member data to identify trends and improve quality of care in accordance with regulations
• Reviews referrals and intake assessments to develop appropriate care plans
• Collaborates with healthcare providers to facilitate services and revise plans as needed
• Collects, documents, and maintains all member information to ensure compliance with guidelines
• Provides and/or facilitates education to members and families on disease processes, care options, referrals, and benefits
• Acts as liaison and member advocate between member/family, physician, and facilities/agencies
• Educates on and coordinates community resources; coordinates service authorization for services based on plans
• May perform home and/or site visits to assess needs and collaborate with resources
• Partners with leadership to improve quality of care and service delivery in a cost-effective manner
• May precept clinical new hires and support onboarding to upskill readiness
• May provide guidance and coaching to new hires/preceptees within an MCO
• May engage during onboarding to complete competency checkpoints for readiness
• Collaborates with People Leaders and cross-functional teams to measure readiness
• Performs other duties as assigned
• Complies with all policies and standards

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”