Location: El Paso, TX
Salary: Depends on Experience
Description:
Judge Healthcare is seeking an RN Case Manager in the El Paso, TX area!
Job Details:
Title: RN Case Manager
Location: El Paso, TX
Type of Engagement: Contract 3-6 months
Rate: Competitive and Dependent on Experience
Specific Duties:
• Responsible for conducting telephonic or face to face holistic evaluations of Member's individual dynamic needs and preferences gathering relevant data and obtaining further information from Member/family identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long-term services and supports.
• Provides education and support to Member/LAR on options of Consumer Directed, or Service-Related delivery models as applicable.
• Performs initial assessments and follow-up assessments and outreach calls within the time specified as part of contractual guidelines or per Member/family/provider request.
• Identifies members for high-risk complications and coordinates care with the member and the health care team.
• Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefit.
• Assess, plan, and implement care strategies that are individualized for each member and directed toward the most appropriate, least restrictive level of care.
• Utilize both company and community-based resources to establish a safe and effective case management plan for members.
• Collaborate with member, family, and healthcare providers to develop an individualized plan of care.
• Identify and initiate referrals for social service programs, including financial, psychosocial, community, and state supportive services.
• Manage care plan throughout the continuum of care as a single point of contact.
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members.
• Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team.
• Utilize approved clinical criteria to assess and determine appropriate level of care for members.
• Document all member assessments, care plan and referrals provided.
• Participate in Interdisciplinary team meetings and Utilization Management rounds and provide information to assist with safe transitions of care.
• Understand insurance products, benefits, coverage limitations, insurance, and governmental regulations as it applies to the health plan.
• Monitor services being delivered to ensure timeliness, appropriateness, and satisfaction in meeting Member needs.
• Reports medically complex cases to appropriate roles as necessary for review and problem solving.
• Maintains status on face-to face- and telephonic visit requirements for assigned Members.
Must have qualifications/experience:
• Education minimum: Requires a current unrestricted RN license in Texas, Graduate of an accredited school of nursing.
• 1+ years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities as a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background required.
• 1+ years of experience working within the community health setting in a health care role.
• 1+ years of experience working in a community health, clinical, hospital, acute care, direct care, or case management setting.
• 2+ years of experience working with MS Word, Excel, and Outlook
• Ability to travel in assigned region to visit Medicaid members in their homes and / or other settings, including community centers, hospitals etc.
• Reliable transportation with valid driver's license with good driving record
• Bilingual - Spanish
• Live in the El Paso, TX area
Hours: 8:00 AM - 5:00 PM (Monday - Friday)
Please send your resume to Emily Hartzell - ehartzell@judge.com for immediate consideration.
Thank you for your time and I look forward to hearing from and working with you.
Regards,
Dominique DeMarco
Recruiting Manager
The Judge Group
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