Care Manager II (RN)
Company: Superior Healthplan
Location: Georgetown
Posted on: April 5, 2021
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Job Description:
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.* 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* Travel
isrequiredEducation/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.Texas
Requirements:Education/Experience: Graduate from an Accredited
School of Nursing. Bachelors 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.Licenses/Certifications: Current states RN license and
driver''s license is required.Centene 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.by Jobble
Keywords: Superior Healthplan, Georgetown , Care Manager II (RN), Executive , Georgetown, Texas
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