Senior LTSS Service Care Manager (RN)
Spectraforce
Mcallen, Texas
17 days ago
Job Description
Title: Senior LTSS Service Care Manager (RN)
Duration: 06 Months - Possibility to extend
Location: Texas – Hidalgo SDA – Brownsville and surrounding cities/towns. Travel to member homes 3 days a week to complete assessments, 2 days remote
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.
Education/Experience:
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
License/Certification:
RN - Registered Nurse - State Licensure and/or Compact State Licensure required or
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 continuously assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed to address member's needs
Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / needs
Monitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicable
Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
Reviews referrals information and intake assessments to develop appropriate care plans / service plans
Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines
Provides and/or facilitates education to long-term care members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
Acts as liaison and member advocate between the member/family, physician, and facilities/agencies
Educates on and coordinates community resources. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living)
May perform home and/or other site visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required
Partners with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness
May provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice
May engage and assist New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
Performs other duties as assigned
Complies with all policies and standards\
About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.
Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.
California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer.
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $44.00/hr.
Duration: 06 Months - Possibility to extend
Location: Texas – Hidalgo SDA – Brownsville and surrounding cities/towns. Travel to member homes 3 days a week to complete assessments, 2 days remote
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.
Education/Experience:
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
License/Certification:
RN - Registered Nurse - State Licensure and/or Compact State Licensure required or
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 continuously assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed to address member's needs
Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / needs
Monitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicable
Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
Reviews referrals information and intake assessments to develop appropriate care plans / service plans
Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines
Provides and/or facilitates education to long-term care members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
Acts as liaison and member advocate between the member/family, physician, and facilities/agencies
Educates on and coordinates community resources. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living)
May perform home and/or other site visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required
Partners with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness
May provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice
May engage and assist New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
Performs other duties as assigned
Complies with all policies and standards\
- Completing assessments
- Completing biannual
- Telephonic outreaches
- Care coordination
- Follow up on request from members/LAR
- Complete any assigned trainings.
- Completing all required documentation
- Submitting authorizations
- Travel (home visit to complete assessments)
- Maintaining at least 92% audit score
- Providing member/LAR education
- Productivity reports
- Follow up with HEDIS measures
- Assisting members/LARs with finding doctors, therapy agency, PCS agency, DME and etc…
| Education/Certification | Required: | Preferred: | |
| Licensure | Required: RN License | Preferred: | |
| Must haves: They will have to have the RN license and pediatrics is a plus. Outlook, excel, word, Microsoft teams experience. Nice to haves: Pediatrics Experience Disqualifiers: Performance indicators: Best vs. average: | ||
About Us: Established in 2004, SPECTRAFORCE® is one of the largest and fastest-growing diversity-owned staffing firms in the US. The growth of our company is a direct result of our global client service delivery model that is powered by our state-of-the-art A.I. proprietary talent acquisition platform, robust ISO 9001:2015/ISO 27001 certified processes, and strong and passionate client engaged teams. We have built our business by providing talent and project-based solutions, including Contingent, Permanent, and Statement of Work (SOW) services to over 140 clients in the US, Canada, Puerto Rico, Costa Rica, and India. Key industries that we service include Technology, Financial Services, Life Sciences, Healthcare, Telecom, Retail, Utilities and Transportation. SPECTRAFORCE is built on a concept of “human connection,” defined by our branding attitude of NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people and clients can reach their highest potential. Learn more at: http://www.spectraforce.com
Benefits: SPECTRAFORCE offers ACA compliant health benefits as well as dental, vision, accident, critical illness, voluntary life, and hospital indemnity insurances to eligible employees. Additional benefits offered to eligible employees include commuter benefits, 401K plan with matching, and a referral bonus program. SPECTRAFORCE provides unpaid leave as well as paid sick leave when required by law.
Equal Opportunity Employer: SPECTRAFORCE is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, sexual orientation, gender identity, genetic information, disability or veteran status, or any other category protected by applicable federal, state, or local laws. Please contact Human Resources at LOA@spectraforce.com if you require reasonable accommodation.
California Applicant Notice: SPECTRAFORCE is committed to complying with the California Privacy Rights Act (“CPRA”) effective January 1, 2023; and all data privacy laws in the jurisdictions in which it recruits and hires employees. A Notice to California Job Applicants Regarding the Collection of Personal Information can be located on our website. Applicants with disabilities may access this notice in an alternative format by contacting NAHR@spectraforce.com.
LA County, CA Applicant Notice: If you are selected for this position with SPECTRAFORCE, your offer is contingent upon the satisfactory completion of several requirements, including but not limited to, a criminal background check. We consider qualified applicants with arrest or conviction records for employment in accordance with all local ordinances and state laws, including the Los Angeles County Fair Chance Ordinance for Employers (FCO) and the California Fair Chance Act (FCA). The background check assessment will consider whether a criminal history could reasonably have a direct, adverse impact on the job-related safety, security, trust, regulatory compliance, or suitability for this role. Such findings may result in withdrawal of a conditional job offer.
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $44.00/hr.