Case Manager, Registered Nurse – Field

Role Overview

• Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members
• The position requires advanced clinical judgment and critical thinking skills to facilitate appropriate physical, behavioral health, psychosocial wrap around services
• Responsible for care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner
• Conduct face to face visits in the members home utilizing comprehensive assessment tools for members enrolled in Long-Term Services and Support programs
• Responsible for coordinating and collaborating care with the member/authorized representative, PCP, and any other care team participants
• Schedule and attend interdisciplinary meetings and advocate on the members behalf to ensure proper and safe discharge with appropriate services in place
• Work with the member and care team to develop a care plan and authorize services in a cost-effective manner within the LTSS benefit
• Document accurately and timely in the member’s electronic health record
• Assessment of Members: conduct comprehensive evaluation of referred member’s needs/eligibility and recommend an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services
• Identify high risk factors and service needs that may impact members outcome and care planning components with appropriate referrals
• Enhance Medical Appropriateness and Quality of Care: present cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes
• Identify and escalate quality of care issues through established channels
• Utilize negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
• Utilize influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
• Provide coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
• Help member actively and knowledgeably participate with their provider in healthcare decision-making

Requirements

• Active and unrestricted RN license in the state of TX
• Minimum 2 years of clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care
• Willing and able to travel up to 50% of their time meet members face to face in Dallas/Tarrant counties of TX and surrounding counties/ areas
• Reliable transportation required; mileage are reimbursed as per company policy
• 1 year experience of Case Management (preferred)
• Managed care organization (MCO) experience (preferred)
• Pediatric experience (preferred)
• Star Kids experience (preferred)
• Bilingual preferred (Spanish)

Benefits

• medical, dental, and vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources, based on eligibility