RN Case Manager - Health Plan

Location:

Remote - TX

Department:

STAR/CHIP CM

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Performs case management activities across the continuum of care in order to promote and facilitate quality, cost effective outcomes and minimize fragmentation of health care delivery for the assigned member population. The Health Plan Case Manager identifies and coordinates short and long term needs of catastrophically/chronically ill and/or injured children/adolescents and their families.

Additional Information:

This RN Case Management position will work remotely to perform case management activities across the continuum of care in order to promote and facilitate quality, cost-effective outcomes and minimize fragmentation of health care delivery for the assigned member population. The Health Plan Case Manager identifies and coordinates short and long-term needs of catastrophically/chronically ill and/or injured children/adolescents and their families. Members may have behavioral health conditions, pediatric conditions, high-risk pregnancy, targeted chronic conditions, or need transition of care services. The Case Manager acts as a member advocate, facilitates communication and coordinates care with physicians, clinics, hospital facilities, family, caregivers and other healthcare providers and implements creative solutions to meet members healthcare needs without compromising quality outcomes. Expectations also include supporting health risk reduction through behavioral change and patient education. Case Management activities are completed primarily by telephone.

• Associate degree in nursing, BSN preferred.
• Three (3) years experience of any combination of experiences working in/with case management, care coordination, utilization review, patient intake, discharge planning and troubleshooting fund resources, quality assurance, clinical pathways, continuous quality improvement, or state and federal health plans or commercial insurance plans in a clinical or managed care environment.
• Competent in Microsoft Office software, general computer knowledge and ability to type and use computers required.
• Must be familiar with various community resources and charitable organizations.
• Must be able to adapt to changing healthcare environments and work with all members of the healthcare team to achieve positive outcomes.
• Must have experience using or navigating electronic medical records (e.g., EPIC, Meditech, Healthy Planet, etc.).
• Bilingual (English/Spanish) preferred.

• Current RN license from Texas Board of Nursing required
• Certification in Case Management (CCM) preferred.