Job Description

Location: REMOTE, Sourcing from Galveston, Brazoria, Chambers, and lower southeast Harris county.

Travel Requirements: Per HM: It's changing all the time, so I can\'t make set guidelines, but I would say the expectation is 50/50 hybrid. At times one may be asked to travel 2-3 hrs away

SHIFT: 8-5pm, no overtime required

: 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.

Education/Experience: 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.

Licenses/Certifications: Current state's RN license.

Texas Requirements:
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 working 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.

Job Duties:

• 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 member 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 Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD):
• Perform duties related to the day-to-day operations of the Service Management functions for Foster Care members to achieve the highest possible levels of functioning and wellness by ensuring consistent, timely access to medically necessary physical health services. Monitor quality of care, assist with discharge planning.

Describe the performance expectations/metrics for this individual and their team:

• Work with Foster Care Members, Medical Consenters, Department of Family and Protective Services (DFPS) staff and providers to meet the healthcare needs of each foster care member's condition.

• Conduct health assessments IN-PERSON and identify foster care members who may benefit from service management, conduct an assessment and develop, implement and monitor a healthcare service plan.
• Provide information to DFPS staff to facilitate development of the DFPS case plan.
• Update database regularly with most recent Service Management Plan of Care.
• Review information submitted by providers into the database to ensure material is appropriate and consistent with guidelines for data inclusion.
• Encourage health providers to use evidence-based practices and confirm that health providers and PCP's are sharing information as required.
• Comply with established referral, pre-certification and authorization policies, procedures and processes by related medical management staff.
• Maintain compliance with federal and state regulations and contractual agreements.
• Coordinate service management functions with other departmental functions.
• Monitor data to address trends or potential quality improvement opportunities and maintain HIPPA compliance.
• Travel is required, and mileage reimbursement is provided**** Tell me about what their first day looks like:
• their first day should be logging into to join the IT meeting at 8:30am to get logged in and set up and then they should expect a call from the hiring manager

What previous job titles or background work well in this role?

• 3+ years\' experience working with children and adolescents with special needs health conditions within CPS, DFPS, child welfare systems, or local and state mental health authorities.
• Emergency Department/ICU
• Case management
• Pediatrics
• Registered Nurse

What makes your team/department/culture special that you would like candidates to know?

• Client is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Any future projected positions potentially coming up? NO If yes, note: 3 positions available, no additional expected
Internal/External Groups with which the Candidate will interface:
Required Skills/Experience: Preferred Skills/ Experience:
Willing to make in person home visits 1. Adapt to Virtual company culture IE. Be on camera when requested
Self-motivated, autonomy, self-directed 2. Hospital experience is valuable
flexible 3.
Education Requirement: Associates in Nursing or Bachelor of Science in Nursing Education Preferred: Registered Nurse
Software Skills Required: Excel, Word, Teams, Outlook, Zoom etc.
Required Certifications: Required Testing:

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