Senior LTSS Service Care Manager; RN - J01077

Overview

RN Care Manager – Complex Care, full-time. The role coordinates care for members with complex medical and long-term care needs, develops personalized care plans, collaborates with interdisciplinary teams, and advocates for members to ensure high-quality, cost-effective, person-centered care across the continuum of care.

• Assess high-risk and medically complex members to develop individualized care plans
• Coordinate services with physicians, specialists, caregivers, and community providers
• Monitor member progress, identify changes in condition, and update care plans as needed
• Educate members and caregivers on disease management, treatment options, healthcare benefits, and available community resources
• Review referrals, clinical assessments, and member data to improve care quality and outcomes
• Coordinate service authorizations and access to long-term care services, transportation, housing, meals, and other support programs
• Maintain accurate clinical documentation in compliance with state, federal, and organizational guidelines
• Conduct home and community visits when required to assess member needs
• Collaborate with interdisciplinary teams to improve quality, compliance, and member satisfaction
• Mentor and support newly hired clinical staff through onboarding, coaching, and clinical guidance as needed

• Active Registered Nurse (RN) license in the applicable state or Compact State License, or active Nurse Practitioner (NP) license
• Graduate of an accredited School of Nursing or Bachelor’s degree with 4-6 years of related healthcare experience
• Experience in care management, case management, service coordination, or long-term care
• Experience managing complex or high-acuity patient populations
• Strong knowledge of care planning, clinical assessment, and healthcare coordination
• Excellent communication, documentation, organizational, and problem-solving skills
• Ability to work independently while managing multiple priorities
• Proficiency with electronic medical records and clinical documentation systems

• Bachelor of Science in Nursing (BSN)
• Experience in Managed Care, Medicaid, Medicare, or Long-Term Services and Supports (LTSS)
• Experience coordinating care for complex medical or behavioral health populations
• Resource Utilization Group (RUG) Certification or ability to obtain if required
• Experience mentoring, precepting, or training clinical staff

• Field-based position with periodic home and community visits
• Local travel may be required based on member needs
• Opportunity to improve healthcare outcomes for medically complex populations while working with a collaborative interdisciplinary team