Case Management Coord II (Must be a RN)
About The Position
This position is responsible for performing concurrent review in accordance with accepted Department Criteria; performing discharge planning and identifying alternate treatment programs that provide medically necessary potentially cost effective services. Consulting with physicians, providers, members, and other resources, as appropriate, to assess, plan, facilitate implementation, coordinate, monitor, and evaluate options and services required to meet an individual's health needs, using communication and available resources to promote quality, cost effective outcomes. Serving as liaison to physicians, and members; serving as preceptor for less experienced staff. This position will perform face to face visits in San Antonio and provide telephonic support for all other locations. Ability and willingness to travel within assigned location.
Requirements
- Register Nurse (RN) with current, valid, unrestricted license in state of operations or reciprocity
- 2 years of clinical experience of direct clinical care to the consumer
- 1 year experience in health insurance/managed care
- Customer Service oriented
- PC proficiency to include Word, Excel, Lotus Notes and database experience
- Clear and concise verbal and written communication skills
- Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management
- Incumbents with other clinical licenses are not required to obtain multi-state licenses
Nice To Haves
- 3 years clinical experience
- Medicare knowledge a plus
- Experience in Disease Management
- Experience in managing complex or catastrophic cases
- Working toward CM certification or Advanced degree
- Knowledge of medical management policies and procedures
- Bilingual in Spanish/English or Polish/English (not required but a plus)
Responsibilities
- Performing concurrent review in accordance with accepted Department Criteria
- Performing discharge planning and identifying alternate treatment programs that provide medically necessary potentially cost effective services
- Consulting with physicians, providers, members, and other resources, as appropriate, to assess, plan, facilitate implementation, coordinate, monitor, and evaluate options and services required to meet an individual's health needs, using communication and available resources to promote quality, cost effective outcomes
- Serving as liaison to physicians, and members
- Serving as preceptor for less experienced staff
- Performing face to face visits in San Antonio and provide telephonic support for all other locations
- Ability and willingness to travel within assigned location
Benefits
- health and wellness benefits
- 401(k) savings plan
- pension plan
- a minimum of 15 days’ of paid time off
- paid parental leave
- disability insurance
- supplemental life insurance
- employee assistance program
- paid holidays
- tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
