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 complexhigh acuity populations with primary medicalphysical health needs to promote quality, cost effective care. Develops a personalized care plan service plan for longterm care members, addresses issues, and educates members and their familiescaregivers on services and benefit options available to receive appropriate highquality care.EducationExperience:Requires Graduate from an Accredited School or Nursing or a Bachelors degree and 46 years of related experienceBachelors degree in Nursing preferredLicenseCertification: RN Registered Nurse State Licensure andor Compact State Licensure required or NP Nurse Practitioner Current States Nurse Licensure required For Superior: Resource Utilization Group RUG certification requiredEvaluates the service needs of the most complex or high riskhigh acuity members and recommends a plan for the best outcome Develops and continuously assesses ongoing longterm care plans service plans and collaborates with care management team to identify providers, specialists, andor community resources needed to address members needs Coordinates and manages as appropriate between the member andor familycaregivers and the care provider team to ensure members are receiving adequate and appropriate personcentered care or services Monitors care plans service plans andor 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 members goals needsMonitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care andor waiver eligibility, as applicableReviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulationsReviews referrals information and intake assessments to develop appropriate care plans service plansCollaborates with healthcare providers as appropriate to facilitate member services andor treatments and determine a revised care plan for member if neededCollects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines Provides andor facilitates education to longterm care members and their familiescaregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefitsActs as liaison and member advocate between the memberfamily, physician, and facilitiesagenciesEducates 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 andor other site visits e.g., once a month or more, such as to assess member needs and collaborate with resources, as requiredPartners with leadership team to improve and enhance quality of care and service delivery for longterm care members in a costeffective mannerMay 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 hirespreceptees in navigating within a Managed Care Organization MCO and provides coaching and shadowing opportunities to bridge gap between classroom training and field practiceMay engage and assist New HirePreceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination successEngages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readinessPerforms other duties as assignedComplies with all policies and standards 
 
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: $ 7.25/hr.