Full-Time

Senior LTSS Service Care Manager RN

Posted on 9/3/2025

Centene

Centene

10,001+ employees

Local health insurance and care services

Compensation Overview

$35k - $63.8k/yr

Dallas, TX, USA

Hybrid

Hybrid role with field visits; must reside in Texas; remote work from home part of schedule.

Category
Medical, Clinical & Veterinary (2)
,
Requirements
  • Must be licensed and reside in the state of Texas.
  • RN - Registered Nurse - State Licensure and/or Compact State Licensure required or NP - Nurse Practitioner - Current State's Nurse Licensure required
  • Resource Utilization Group (RUG) certification must be obtained within 90 days of hire required
  • 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
Responsibilities
  • 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.
  • 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

Centene provides health insurance and related health services to underinsured and uninsured individuals, serving primarily through the Health Insurance Marketplace and a network of local brands and teams across the United States. It collects premiums from members and delivers access to medical, dental, vision, behavioral health, and pharmacy benefits, aiming to offer cost-effective care. The company differentiates itself with a localized, community-focused operating model that tailors offerings to each community while leveraging a wide range of services and scale to manage costs. Its goal is to improve health outcomes and overall well-being for its members while maintaining responsible governance and sustainability efforts on environmental and social fronts.

Company Size

10,001+

Company Stage

IPO

Headquarters

St. Louis, Missouri

Founded

1984

Simplify Jobs

Simplify's Take

What believers are saying

  • Q1 2026 EPS of $3.37 beats estimates, raises full-year guidance $1B.
  • CMS boosts 2027 Medicare Advantage rates for revenue uplift.
  • Daniel Finke and Michael Carson strengthen Medicaid, Medicare leadership.

What critics are saying

  • Big Beautiful Bill expels millions from Medicaid, slashing 28.5M members.
  • ACA enrollment drops 1.5M for Ambetter from subsidy expiration.
  • $1T Medicaid cuts over 10 years collapse Centene's core revenue.

What makes Centene unique

  • Centene leads as largest Medicaid managed care organization nationwide.
  • Wellcare serves 9.1 million Medicare members across all 50 states.
  • Longest-running carrier in Health Insurance Marketplace since 1984.

Help us improve and share your feedback! Did you find this helpful?

Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Vacation

Hybrid Work Options

Flexible Work Hours

Company News

Yahoo Finance
Apr 9th, 2026
Centene creates new Medicare leadership role amid payment pressures and cost challenges

Centene Corporation has created two new executive leadership roles, hiring Daniel Finke as Group President, Markets and Commercial, and promoting Michael Carson to Group President, Medicare and Specialty. Both positions report directly to CEO Sarah London and oversee the company's Medicaid, Commercial, Medicare and Specialty businesses. The restructuring comes as Centene faces pressure from Medicare payment updates and medical cost volatility. Whilst CMS has increased 2027 Medicare Advantage rates, Deutsche Bank notes revenues may still lag rising medical costs, potentially pressuring profitability. The leadership changes do not materially alter Centene's near-term investment drivers, which remain centred on managing medical costs and navigating rate adequacy across Medicaid and Marketplace programmes. Analyst projections vary significantly, with revenue forecasts ranging from $181.3 billion to $195.6 billion by 2028.

Southwest Medical Consulting
Apr 6th, 2026
Centene creates two new executive leadership roles.

Centene creates two new executive leadership roles. It's the latest in a flurry of executive appointments from health insurers looking to strengthen their leadership teams amid regulatory headwinds and elevated medical costs.

Yahoo Finance
Apr 6th, 2026
Centene appoints Daniel Finke as group president, markets and commercial

Centene Corporation has appointed two executives to new group president roles under CEO Sarah London. Daniel Finke joins as group president for markets and commercial, whilst Michael Carson becomes group president for Medicare and specialty. Finke brings over 20 years of healthcare experience, most recently serving as CEO of Convey Health Solutions. He previously held senior positions at CVS Health and Aetna, overseeing Medicare, Medicaid and commercial insurance operations. At Centene, he will oversee the Medicaid and commercial segments. Carson, who joined Centene in January 2024 as Wellcare CEO, will now have expanded oversight of Medicare Advantage, Medicare Part D, Duals and specialty businesses. He has nearly 30 years of healthcare leadership experience, including CEO roles at Bright Healthcare and Harvard Pilgrim Health Care.

Forbes
Apr 6th, 2026
Centene latest health insurer to shakeup management ranks.

Centene latest health insurer to shakeup management ranks. ByBruce Japsen, Senior Contributor. Bruce Japsen writes about healthcare business and policy. Apr 06, 2026, 08:26am EDT Apr 06, 2026, 09:00am EDT Centene is bolstering its management team by creating two new senior executive positions as health insurers battle higher costs and new policies at the federal level. Like many of its rival health insurers, the company has been battling rising medical expenses from customers in its health plans and its stock price has been hit hard. In Centene's case, the company is also facing policy changes after the Republican-led Congress and the Donald Trump White House refused to renew enhanced subsidies for millions of Americans who buy individual coverage under the Affordable Care Act, also known as Obamacare. Centene said Monday it has created two "new executive leadership positions" which will report to company chief executive Sarah London, hiring Daniel Finke as group president, markets and commercial as well as Michael Carson as group president, Medicare and specialty. Both have extensive experience in the health insurance industry, Centene said. Finke's background includes work as CEO of Convey Health Solutions and a top leadership role at CVS Health's Aetna, the nation's third-largest health insurance company. Meanwhile, Centene said Carson "will have expanded oversight of Centene's Medicare Advantage, Medicare Part D, Duals, and Specialty businesses." Carson, who joined Centene in January of 2024, was CEO of "Bright Healthcare and Harvard Pilgrim Health Care, as well as CareAbout, a multi-specialty, value-based care delivery organization," the company said. "We are pleased to recognize Michael's continued leadership and excited to leverage Dan's deep industry expertise and track record of strategic execution," said Sarah London, Chief Executive Officer of Centene. "Their collective experience will be instrumental as we continue to strengthen performance across the portfolio and deliver sustainable, profitable growth." Several other health insurers have been bringing in new executives or replacing CEOs in the last two years. Just last week, Elevance Health made several changes to its management ranks at both the health insurance business and its Carelon health services that includes new chief finance officers at each unit. MORE FOR YOU In February, Centene reported a loss of more than $1 billion in the fourth quarter of last year as the company continued to struggle with rising healthcare costs in the government-subsidized health plans it administers and sells. Centene is seeing rising costs among health plan members in all three government-subsidized benefits it helps manage: Medicaid, Medicare Advantage for older adults and Obamacare. In addition, Centene said the company's Obamacare enrollment is down more than 1.5 million from just a few months ago in what many analysts see as a sign Americans can no longer pay for health insurance and are dropping coverage. The Prompt: Get the week's biggest AI news on the buzziest companies and boldest breakthroughs, in your inbox. London told analysts and investors that the company, which is historically the largest publicly traded provider of Obamacare, was on track for "roughly 3.5 million members by the end of the quarter with still some movement as we work through the grace period in March." That's down from more than 5 million enrollees in Centene's Ambetter brand plans who purchased coverage on the ACA's marketplaces for last year. The big dip in Centene's enrollment is what Democrats in Congress and health insurance industry analysts said would happen after Republicans in Congress and the Donald Trump White House wouldn't agree to extend enhanced tax credits for buyers of Obamacare. A KFF analysis last fall said middle income Americans "as well as those with low incomes" will see "major out-of-pocket premium increases" if tax credits aren't extended. And they are with customers reporting a doubling and even tripling of premiums for this year. The subsidies, or tax credits, made health insurance premiums more affordable for individuals and were enhanced by the Biden administration and the Democratic-controlled Congress, which passed the Inflation Reduction Act of 2022, allowing more Americans to buy coverage. The enhanced subsidies helped enrollment in the ACA's individual coverage, also known as Obamacare, eclipse a record 24 million Americans and help its popularity hit all-time highs. The Trump administration, via the Centers for Medicare & Medicaid Services, said in late January that 23 million consumers "have signed up for 2026 individual market health insurance coverage through the Marketplaces since the start of the 2026 Marketplace Open Enrollment Period on November 1, 2025." Read our community guidelines. LOADING VIDEO PLAYER... Video unavailable FORBES' FEATURED Video Less than $1.50/week. Become a Forbes Member. Unlock limitless insights and exclusive benefits.

Healthcare Dive
Apr 6th, 2026
Centene creates two new executive leadership roles.

Centene creates two new executive leadership roles. It's the latest in a flurry of executive appointments from health insurers looking to strengthen their leadership teams amid regulatory headwinds and elevated medical costs. Published April 6, 2026 Dive brief: * Centene has created two new executive leadership positions to consolidate oversight of its Medicaid, Medicare and Affordable Care Act businesses as the insurer copes with rising costs and looming policy challenges. * Centene has hired longtime health insurance executive Daniel Finke as its inaugural group president of markets and commercial, the company announced Monday. Centene also named Michael Carson, the CEO of its Medicare business, as group president of Medicare and specialty. * Both executives will report to Centene CEO Sarah London. Centene did not respond to a request for comment about when the appointments are effective. Dive insight: Centene is the largest insurer in both the Medicaid and ACA markets, with its almost 28 million members heavily concentrated in those businesses. As such, the company is significantly exposed to policy changes in those programs, and is currently working to digest recent policy changes that threaten its finances. Centene reported a loss of almost $6.7 billion on revenues of almost $195 billion last year, mostly from recording a massive charge to reflect its waning value amid challenging market conditions, including Republican cuts to the healthcare system. Still, the company issued a higher earnings outlook for 2026 than market watchers had expected, betting that it can stabilize elevated medical costs and weather policy turmoil coming out of Washington. The GOP's "Big Beautiful Bill" enacted last summer is set to cause millions of individuals to lose Medicaid through new work requirements, stricter eligibility and enrollment processes and lower federal funding. Meanwhile, the ACA marketplaces contracted this year after Congress allowed more generous subsidies for coverage to expire, and efforts by the Trump administration to combat fraud are also expected to boot more individuals off the exchanges. In a statement, London said the two new executives will be "instrumental" as Centene looks to strengthen its performance. Finke, who will oversee Centene's Medicaid and ACA segments, joins Centene from health technology and services company Convey Health Solutions, where he was CEO. Prior to joining Convey in 2024, Finke spent roughly a decade in various leadership roles at CVS and its health insurance division Aetna. Carson, who has been the chief executive of Centene's Medicare business Wellcare since 2024, will have expanded oversight of Centene's MA, prescription drug, dual-eligible and other Medicare businesses as group president of Medicare and specialty, the company announced. It's the latest in a flurry of executive appointments from health insurers as the companies contend with regulatory headwinds and rising costs. Elevance beefed up its roster of mid-level executives last week after reshuffling its C-suite earlier this year. Recommended reading. Filed Under: Payer

INACTIVE