- Superior HealthPlan
- Dallas, TX
- 02-13-2024
Care Manager RN
Location: SDA Bryan/College Station, TX
Job Type: Hybrid Position
Job Description
As a Care Manager RN at Superior HealthPlan, you will play a crucial role in assessing, planning, and coordinating all aspects of medical and supporting services across the continuum of care for select members. This is a hybrid position located in SDA Bryan/College Station, TX. You will have the opportunity to make a significant impact on the health and well-being of our members by promoting quality, cost-effective care.
Responsibilities
- 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.
- 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 and facilitate member access to community-based services.
- Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems.
- Coordinate service requests/authorizations with UM and ensure agreement is aligned between the member, agency, and MCO.
- Communicate status of member health indicators with agency staff that can contribute to the successful community living of members.
- Participate in weekly rounds with agency staff and perform other related duties as assigned.
Requirements
- Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred.
- Current state’s RN license and 2+ years of clinical nursing experience in a clinical, acute care, or community setting.
- 1+ years of case management experience in a managed care setting and 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.
Salary
Pay Range: $66,100.00 - $118,900.00 per year
Benefits
- Competitive pay and comprehensive benefits package.
- Flexible work solutions including remote options, hybrid work schedules, and dress flexibility.
- Paid time off including holidays and health insurance coverage for you and your dependents.
- 401(k) and stock purchase plans, tuition reimbursement, and best-in-class training and development.