Care Manager RN - Foster Care

Job Description

Superior HealthPlan is seeking a Care Manager RN for Foster Care to join our Medical Management/Health Services team. This hybrid position requires the candidate to be licensed and reside in Texas, with a preference for pediatric experience. The role involves assessing, planning, and coordinating all aspects of medical and supporting services across the continuum of care for select members, promoting quality and cost-effective care.

Responsibilities

• Assess the member's health status, resource utilization, treatment plan, and services to develop a care plan based on specific objectives and interventions.
• Coordinate services between healthcare providers, specialists, and non-medical staff to meet the medical socio-economic needs of clients.
• Provide patient and provider education and facilitate member access to community-based services.
• Monitor referrals made to community-based organizations, medical care, and other services to support members' overall care management plan.
• Actively engage in integrated team care management rounds and identify related risk management quality concerns.
• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems.
• Coordinate the overall care management activities provided to the target population.
• Participate in case management committees and handle special projects related to case management as needed.

Requirements

• Graduate from an Accredited School of Nursing, with a 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.
• Experience with utilization management principles and healthcare managed care.
• Current state’s RN license.
• Texas-specific requirements: 2+ years of clinical nursing or case management experience, experience working with people with disabilities and vulnerable populations, and familiarity with medical decision support tools and government-sponsored managed care programs.

Benefits

• Competitive pay ranging from $66,100.00 to $118,900.00 per year.
• Flexible work solutions including remote options, hybrid work schedules, and dress flexibility.
• Paid time off including holidays.
• Health insurance coverage for you and your dependents.
• 401(k) and stock purchase plans.
• Tuition reimbursement and best-in-class training and development.