Senior LTSS Service Care Manager (RN)

Position Summary:

• Our team is a remote team across Texas who specialize in the service coordination/case management for children with special needs, specifically the IDD (intellectual and developmental disability) waivers.
• These waivers are the CLASS, DBMD, TxHmL and HCS waivers.
• Our team is responsible for coordinating with the IDD waiver CMs and making sure all needs are met.
• We work closely with our members to ensure regular assessments are completed, both telephonically and in person visits (in member's homes).
• We work with private duty nursing agencies, DME providers, pharmacies and doctor's offices to ensure all needed services are in place or are being coordinated to be put into place.

Background & Context:

• Our team is a remote team across Texas who specialize in the service coordination/case management for children with special needs, specifically the IDD (intellectual and developmental disability) waivers.
• These waivers are the CLASS, DBMD, TxHmL and HCS waivers.
• Our team is responsible for coordinating with the IDD waiver CMs and making sure all needs are met.
• We work closely with our members to ensure regular assessments are completed, both telephonically and in person visits (in member's homes).
• We work with private duty nursing agencies, DME providers, pharmacies and doctor's offices to ensure all needed services are in place or are being coordinated to be put into place.

Key Responsibilities:

• The position is from 8am-5pm CST Monday-Friday with an hour lunch, OT is next expected while in training but once a caseload is assumed and staff are managing member needs OT may be possible.
• Additionally, late visits or weekend visits may be needed if a family request, which may result in OT.
• Our team communicates regularly through our teams chat, bi-weekly team meetings and 1:1 w/ preceptor, team lead and manager.
• Day to day, task change regularly, you may be doing home visits in the field or you may be working on telephonic follow ups from your home office.
• We carry caseloads around 65 cases and have expectations to manage both field visits done quarterly with telephonic outreaches done monthly.
• Some needs may need daily follow up or even follow up multiple times a day with different departments depending on what it is.
• Each day varies and keeps the role interesting and ever changing.

Qualification & Experience:

• Required: Associate's Degree
• Preferred: BSN
• Required: RN
• Preferred: n/a

Must-haves:

• 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting.
• Knowledge of utilization management principles and healthcare managed care.
• Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.
• Bilingual (Spanish).

Nice to haves:

• 2+ years of clinical nursing or case management experience in a clinical, acute care, managed care or community setting.
• 2+ years experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment.
• Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs.