Care Manager II (RN)
Company: Superior HealthPlan
Location: Rio Grande City
Posted on: February 20, 2021
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Job Description:
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 is required 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.
Licenses/Certifications: Current state's RN license and driver's
license is required. NOTE: Once RN staff are authorized to resume
field visits, RN Case Manager travels to conduct member assessments
in the Hidalgo County/Starr County area and surrounding areas of
Rio Grande City, Roma, La Joya, Mission, McAllen, Mercedes, Alamo,
TX. 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.
Keywords: Superior HealthPlan, Mission , Care Manager II (RN), Healthcare , Rio Grande City, Texas
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