LTSS Service Care Manager

📋 Description

• • Centene Corporation is seeking a dedicated and compassionate LTSS Service Care Manager to join our Sunshine Health Long Term Services and Supports (LTSS) team. This pivotal role is designed for individuals passionate about transforming the health of our 28 million members by providing essential support and care coordination within their communities. As a diversified, national organization, Centene offers a dynamic work environment with competitive benefits and a fresh perspective on workplace flexibility, making this an ideal opportunity to make a significant impact.
• • This is a hybrid role, specifically covering the Pinellas County area, including Clearwater, Largo, and Safety Harbor. The position is predominantly field-based, with approximately 75% of your time dedicated to visiting members in their homes or designated facilities. This hands-on approach ensures that you are directly involved in understanding and addressing the unique needs of each member. When not actively engaged in member visits, you will have the opportunity to work remotely, offering a balanced approach to your work schedule. Standard work hours are Monday through Friday, from 8:00 AM to 5:00 PM local time, providing a predictable and manageable weekly commitment.
• • The core of this role involves providing comprehensive case management support to members requiring Long Term Services and Supports. You will be instrumental in developing, assessing, and coordinating holistic care management activities. Your primary objective will be to enable quality, cost-effective healthcare outcomes for members navigating complex long-term care needs. This includes developing personalized service care plans tailored to individual member requirements and educating members, their families, and caregivers about the available services and benefits designed to meet their specific needs.
• • A key responsibility is to evaluate the unique needs of each member, assess the available resources within their community, and recommend or facilitate the most appropriate plan for optimal outcomes. You will work collaboratively to develop ongoing long-term care plans and service plans, actively identifying and coordinating with necessary providers, specialists, and community resources essential for comprehensive long-term care.
• • You will serve as a crucial liaison, coordinating effectively between the member, their family/caregivers, and the broader care provider team to ensure that identified services are readily accessible and utilized. Furthermore, you will provide vital resource support to members and their families/caregivers, assisting them with a wide range of needs such as employment opportunities, housing assistance, participant direction services, independent living support, justice-related services, and foster care resources, all based on thorough service assessments and established plans.
• • Continuous monitoring of care plans and service plans is essential. You will track member status and outcomes, making informed recommendations for adjustments to care plans based on evolving member needs and circumstances. This proactive approach ensures that care remains relevant and effective over time.
• • You will engage actively with long-term care healthcare providers and community partners, fostering strong relationships to ensure seamless and comprehensive care delivery. This collaborative effort is vital for meeting the multifaceted needs of our members.
• • Meticulous documentation is a critical aspect of this role. You will be responsible for collecting, documenting, and maintaining all long-term care member information and care management activities. This ensures strict compliance with current state, federal, and third-party payer regulations, maintaining the integrity and accuracy of member records.
• • The role may involve conducting home visits and other site visits to conduct thorough assessments of member needs and to collaborate directly with healthcare providers and partners in their environment. This provides valuable on-the-ground insights.
• • You will play an important role in educating long-term care members and their families/caregivers. This includes providing clear information on procedures, healthcare provider instructions, available service options, referral processes, and healthcare benefits, empowering them to make informed decisions.
• • You are expected to provide constructive feedback to leadership regarding opportunities for improvement and enhancement of the quality of care and service delivery for long-term care members, always with an eye toward cost-effectiveness and efficiency.
• • This role also includes performing other duties as assigned to support the team and the organization's mission, and strictly adhering to all company policies and standards.