Care Manager RN - Pediatrics

Care Manager RN - Pediatrics

Location: Hybrid Position - SDA Travis County, Texas

Job Description

We are seeking a compassionate Care Manager RN to join our Medical Management/Health Services team at Superior HealthPlan. In this role, you will be responsible for coordinating all aspects of medical and supporting services across the continuum of care for select members, to promote quality, cost-effective care.

Responsibilities

• Assess the member's current health status and develop a plan of care based on 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.
• Facilitate member access to community-based services and coordinate service request/authorizations with UM to ensure agreement is aligned between the member, agency, and MCO.
• Participate in case management committees, and work on special projects related to case management as needed.
• Review and approve the initial and ongoing assessment and care plan to ensure requirements are met.
• Actively participate in integrated team care management rounds and identify related risk management quality concerns.

Requirements

• 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.
• Current state’s RN license.
• Experience with medical decision support tools (i.e. Interqual, NCCN) and government-sponsored managed care programs.

Benefits

• Competitive pay: $66,100.00 - $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.