Position Title: Senior LTSS Service Care Manager (RN)
Work Location: Remote Texas (Midland/Odessa or surrounding area)
Assignment Duration: 6 Months (Possibility to convert)
Work Schedule: 8-5 Mon-Fri During training and/or until Perm there should be no expectation of OT
Work Arrangement: Member-facing

Position Summary:
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.

Background & Context:

• Evaluates the service needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome

Key Responsibilities:

• 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 members, 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 assessing member needs and collaborating 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
• Comply with all policies and standards

Qualification & Experience:

• Education/Experience: Requires Graduate from an Accredited School or Nursing or a Bachelor's degree and 4–6 years of related experience (Pediatrics 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 Resource Utilization Group (RUG)/PDPM certification required

Education/Certification	Required: Graduate from an Accredited School of Nursing or a Bachelor's degree		Preferred: Bachelor’s degree in nursing preferred
Licensure	Required: RN		Preferred:
Years of experience required Disqualifiers Best vs. average Performance indicators		Must haves: Minimum of 2–3 years of pediatric nursing experience is required   Nice to have: Case management experience is preferred and considered a strong advantage.  Prior experience working with Medicaid populations or in home/community-based settings is beneficial.   Disqualifiers: Unwillingness or inability to travel for home visits.  Inability to work a consistent Monday–Friday schedule.  Lack of pediatric experience.  Poor organizational skills or inability to manage a caseload independently.  Inability to use Microsoft Office applications, including Excel, Word, and Outlook, for documentation and reporting.   Best candidates: Pediatric RN with strong case management background, highly organized, comfortable in-home settings, skilled in problem-solving, and proficient in Microsoft Office. These candidates are proactive, adaptable, and can balance compliance requirements with family-centered care.  Average candidates: Meet the minimum pediatric experience requirement but may need more coaching in case management, documentation efficiency, or independent field work.    Performance indicators: Completion of assessments, service plans, and follow-up within state-mandated timelines.  Accuracy and quality of documentation in the case management system.  Effective communication with families, providers, and team members.  Ability to solve barriers to care and connect members to needed resources.  Positive feedback from families and providers regarding responsiveness and professionalism.  Demonstrated organization in managing caseload and meeting deadlines with minimal supervision.

 
 
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: $ 40.00/hr.