Nurse Case Manager I
About the role
The Nurse Case Manager I will be responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. The ideal candidate would reside within the following counties within the state of Texas: Angelina, Walker (Huntsville), Tom Green (San Angelo) and Taylor county.
This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. The Nurse Case Manager will be in the field 2x-3x a week based on business needs.
Responsibilities
- Ensures member access to services appropriate to their health needs.
- Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.
- Implements care plan by facilitating referrals as appropriate within benefits structure or through state contractual arrangements.
- Coordinates internal and external resources to meet identified needs.
- Monitors and evaluates effectiveness of the care management plan and modifies as necessary.
- Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.
- Assists in problem solving with providers, claims or service issues.
Requirements
- Requires BA/BS in a health-related field and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
- Current, unrestricted RN license within the state of Texas is required.
- Multi-state licensure is required if this individual is providing services in multiple states.
Skills
- Certification as a Case Manager is preferred.
- Experience with Microsoft TEAMs, Outlook, Word, and Excel.
- Experience with Home Health completing field visits.
- Experience with Medicaid.
- Positive, strong interpersonal and communication skills.
Benefits
- Market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs.
- Medical, dental, vision, short and long term disability benefits.
- 401(k) + match, stock purchase plan, life insurance, wellness programs and financial education resources.