This role focuses on care management for members receiving long-term services and supports, with RN-led assessment, care planning, and ongoing coordination across clinical and community resources. The work centers on helping patients navigate complex needs and connecting them with appropriate services in a managed-care setting. It is a member-facing role that requires strong collaboration, documentation, and follow-up.
Key Responsibilities
- Conduct assessments and develop individualized care plans for members with long-term services and supports needs.
- Coordinate care across providers, community resources, and ancillary services.
- Monitor member progress and update plans based on changing clinical and social needs.
- Support members and families with referrals, navigation, and problem-solving.
- Document assessments, care coordination activities, and case management outcomes.
- Participate in multidisciplinary collaboration to help address complex care needs.
Required
- Active RN licensure.
- Experience in care management, case management, or a related nursing role.
- Knowledge of long-term services and supports or complex care coordination.
Preferred
- Experience working in a managed care or health plan environment.
- Experience supporting Medicaid or other vulnerable populations.
- Familiarity with community-based resources and service coordination.