Care Manager
Job Title: Care Manager II (RN)
Location: Remote (Lubbock, TX)
Duration: 6 Months (Possibility of Extension)
Shift Timing: Standard Shift
Position Purpose
Education/Experience:
Location: Remote (Lubbock, TX)
Duration: 6 Months (Possibility of Extension)
Shift Timing: Standard Shift
Position Purpose
- Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.
- Graduate from an Accredited School of Nursing. Bachelor’s degree in nursing preferred. 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting.
- Knowledge of utilization management principles and healthcare managed care.
- Experience with medical decision support tools (i.e., InterQual, NCCN) and government sponsored managed care programs.
- Current state’s RN license.
Education/Experience:
- Graduate from an Accredited School of Nursing.
- Bachelor’s degree in nursing preferred.
- 2+ years of clinical nursing or case management experience in a clinical, acute care, managed care, or community setting. 2+ years’ experience collaborating with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment.
- Experience with medical decision support tools (i.e., InterQual, NCCN) and government sponsored managed care programs.
- Other state specific requirements may apply.
- Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment, and provider options.
- Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes.
- Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of clients.
- Provide patient and provider education.
- Facilitate members’ access to community-based services.
- Monitor referrals made to community-based organizations, medical care, and other services to support the members’ overall care management plan.
- Actively participate in integrated team care management rounds
- Identify related risk management quality concerns and report these scenarios to the appropriate resources.
- Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience.
- Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems.
- Direct care to participating network providers.
- Perform duties independently, demonstrating advanced understanding of complex care management principles.
- Participate in case management committees and work on special projects related to case management as needed.
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Seniority level
Mid-Senior level -
Employment type
Full-time -
Job function
Health Care Provider -
Industries
Staffing and Recruiting
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