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LTSS Care Manager - Registered Nurse (RN) - Lumberton, NC
at WellCare Health Plans
Lumberton, NC

LTSS Care Manager - Registered Nurse (RN) - Lumberton, NC
at WellCare Health Plans
Lumberton, NC

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This licensed professional will be responsible for the oversight and coordination of long term support services / long term care for special (higher acuity) populations residing in the community and/or skilled nursing facilities. Examples include but are not limited to: individuals with 2 or more, higher risk medical or behavioral health conditions (e.g., COPD and Schizophrenia). This position assumes a leadership role with internal and external partners to achieve optimal health care outcomes for the member through effective coordination of care activities.

REPORTS TO: Director, Field Health Services

DEPARTMENT: Health Services

LOCATION: Lumberton, NC

JOB TYPE: Salary/ Exempt

Essential Functions:

  • Provides care coordination and care management and oversees higher acuity long-term support services / long-term care members. (i.e. individuals with complex medical or behavioral health issues that place populations at greater risk for potentially prevent able events such as avoidable admissions, readmissions, and emergency room visits).
  • Manages an active caseload based on state mandated ratios according to residential setting, case intensity and acuity.
  • Partners effectively with the PCP, Specialist, member, member's family and interdisciplinary care teams (ICT) to develop a Person Centered Care Plan.
  • Utilizes clinical knowledge and expertise to craft strategies aimed at member education to support self-management and achieve optimal health outcomes.
  • In partnership with the member, family, physician(s), ICT and other providers, assesses short and long-term member needs, evaluates the need for supportive e services and establishes member driven care management objectives.
  • Responsible for coordination of service authorizations (i.e. meals, transportation, activities of daily living).
  • Performs clinical interventions such as education on prescribed medication treatment regimens and counseling.
  • Ensures comprehensive assessments and person-centered care plans are completed within required time frames and utilizes clinical knowledge and expertise to assess options for care including use of benefits and community resources.
  • Acts as liaison and member advocate between the member/family, physician and facilities/agencies.
  • Maintains accurate reports and manages the integrity of care management activities in the electronic care management system, using clinical guidelines.
  • Educates on and coordinates community resources, to include medical, behavioral and social services. Applies care management standards and maintains HIPAA standards and confidentiality of protected health information.
  • Ensures compliance with all state and federal regulations and guidelines in day-to-day activities.
  • Participates in performance improvement activities.
  • Performs special projects as assigned.
Additional Responsibilities:

    Candidate Education:

    • Required Other FL LTC Degree requirements are tied to license. See below for details: Associates' degree in Nursing; Bachelor's degree in social work, sociology, psychology, gerontology, or a related social services field; Master's degree in social work, sociology, psychology, gerontology, or a related social services field
    Candidate Experience:
    • Required Other For FL LTC, must meet one of the following: * Possess a minimum of two (2) years of relevant experience and be a Registered Nurse (RN), Licensed Certified Social Worker (LCSW), Licensed Medical Social Therapist (LMST), Licensed Mental Health Counselor (LMHC) and licensed to practice in the State or, *Possess a minimum of four (4) years of relevant experience and be a licensed professional able to practice in the State.
    Candidate Skills:
    • Intermediate Demonstrated written communication skills
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Ability to influence internal and external constituents
    • Intermediate Ability to work as part of a team
    • Intermediate Ability to work independently
    • Intermediate Ability to work in a fast paced environment with changing priorities
    • Intermediate Demonstrated organizational skills
    • Intermediate Other Ability to remain calm under pressure
    • Intermediate Knowledge of healthcare delivery
    • Intermediate Ability to effectively present information and respond to questions from families, members, and providers
    Licenses and Certifications:
    A license in one of the following is required:
    • Required Other CPR Certified
    • Required Other One of the following licenses is required (must be licensed in the state of practice): Registered Nurse (RN) Licensed Practical Nurse (LPN) Licensed Certified Social Worker (LCSW) Licensed Professional Counselor (LPC) Licensed Medical Social Therapist (LMST) Licensed Mental Health Counselor (LMHC)
    Technical Skills:
    • Required Intermediate Microsoft Outlook
    • Required Intermediate Microsoft Word
    • Required Intermediate Microsoft Excel
    • Required Intermediate Healthcare Management Systems (Generic)

      About us
      Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

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