Job Profile Summary
"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 of 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 must be obtained within 90 days of hire required
For Arkansas Total Care plan - This position is designated safety sensitive in Arkansas and requires a driver's license, child and adult maltreatment (before hire and recurring), and a drug screen (at time of hire and recurring). Must reside in AR or border city. Travel: 5%. required
Responsibilities
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
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 requiredEvaluates 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
EEO:
“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”
==========
Job Description:
Job Profile Summary
"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 of 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 must be obtained within 90 days of hire required
For Arkansas Total Care plan - This position is designated safety sensitive in Arkansas and requires a driver's license, child and adult maltreatment (before hire and recurring), and a drug screen (at time of hire and recurring). Must reside in AR or border city. Travel: 5%. required
Responsibilities
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
Story Behind the Need
- What is the purpose of this team?
- Describe the surrounding team (team culture, work environment, etc.) & key projects.
- Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
- To identify any needs new members may have and to continue care for anything placed by prior MCO
- Our team culture is highly collaborative and member-focused. Team members consistently support one another, frequently volunteering assistance and responding quickly to questions. They demonstrate strong accountability through fast turnaround times and a shared commitment to meeting performance expectations. Above all, the team prioritizes member needs by remaining flexible and accommodating reasonable requests whenever possible.
- no
Typical Day in the Role
- Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
- What are performance expectations/metrics?
- What makes this role unique?
- Prepare for visits by gathering information on member utilizing our Electronic Medical Record system reviewing diagnosis, meds, recent authorizations.
- Completing visits that are: Initial, Change in condition, MDCP, and Level 3 reassessments
- Travel to member home for in person visit lasting 2-4 hours long. Travel can be up to 2 hours one way.
- Submission of assessment within 24 hours. Any requests for services to be initiated within 3 business days. All other documentation due within 5 business days. After 15 business days hand off member to appropriate level to be assigned to permanent care manager/service coordinator.
- Complete Centene University trainings prior to due date.
- Complete any task assignments within turnaround time per work process.
Candidate Requirements
Education/Certification
Required: RN ASN, BSN, or MSN
Preferred:
Licensure
Required: RN
Preferred:
Years of experience required:
More than 3 years as nurse and 2 years of case management
Disqualifiers:
Additional qualities to look for: pediatric experience
- Top 3 must-have hard skills stack-ranked by importance
1
Accountability and prioritizing
2
Clinical judgement
3
Ability to take direction
Candidate Review & Selection
- Shortlisting process
- Candidate review & selection
- Interview information
- Onboard process and expectations
Projected Manager Candidate Review Date:
1-2 days post shortlisting
Type of Interviews:
Teams- Camera on
Required Testing or Assessment (by Vendor):
none
Next Steps
- Do you have any upcoming PTO?
- Colleagues to cc/delegate
Compliance Questions
