Clinical - Care Manager II RN

Job Title: Care Manager II (RN)

Duration: 6 months (Possible Extension)

Location: Remote Webb County TX

Shift: Day 5x8Hour (08:00 05:00)

Note:

• Looking for candidates in Webb County area TX

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.

DaytoDay responsibilities:

• Prepare for visits by gathering information on members utilizing our Electronic Medical Record system reviewing diagnosis meds recent authorizations.
• Completing visits that are: Initial Change in condition MDCP and Level 3 reassessments.
• Travel to member home for in person visit lasting 24 hours long. Travel can be up to 2 hours one way.
• Submission of assessment within 24 hours. Any requests for services to be initiated within 3 business days. All other documentation due within 5 business days.
• After 15 business days hand the member to appropriate level to be assigned to permanent care manager/service coordinator.
• Complete any task assignments within turnaround time per work process.
• Complete 6 visits per week
• All documentation submitted within established turnaround times.
• Meet quality metrics.
• Meet 92% on audits.
• Meet 90% on member satisfaction surveys.

Responsibilities:

• Assess the members current health status resource utilization past and present treatment plan and services prognosis short and longterm 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 members needs and promote desired outcomes.
• Coordinate services between Primary Care Physician (PCP) specialists medical providers and nonmedical staff as necessary to meet the complete medical socioeconomic needs of clients.
• Provide patient and provider education.
• Facilitate members access to communitybased services.
• Monitor referrals made to communitybased 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.

Education/Experience:

• Graduate from an Accredited School of Nursing. Bachelors 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.

Licenses/Certifications:

• Current states RN license