Large managed care company is looking for RN Case Managers to develop, monitor, evaluate, and revise the member's care plan and to conduct additional assessments with the goal of optimizing member health care across the care continuum.

WORK LOCATION: MUST reside in El Paso, TX

PAY: $40.00

CONTRACT DATES: 11/11/24 - 5/9/25

HOURS: M-F, 8-5

RESPONSIBILITIES

• 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.
• 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.
• Understand insurance products, benefits, coverage limitations, insurance, and governmental regulations as it applies to the health plan.

QUALIFICATIONS

• Associates Degree
• Requires a current unrestricted RN license in Texas
• 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 in a community health, clinical, hospital, acute care, direct care, or case management setting.
• 2+ years of experience working with MS Word, Excel, Outlook and data entry skills
• 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
  

PREFERRED QUALIFICATIONS

• Bachelor’s Degree
  
• CCM/RUG Certified
  
• Current certificates of completion for Texas HHSC STAR+PLUS required trainings
• Experience with electronic charting
• Experience with arranging community resources
• Field-based work experience
• 2+ years of experience working with Medicaid Waiver populations
• Behavioral Health Experience
• Background in managing populations with complex medical or behavioral needs