Case Manager II

Health Care Service Corporation•Houston, TX

1d•$76,600 - $138,500•Hybrid

About The Position

The Case Manager II performs concurrent reviews in accordance with accepted department criteria and conducts discharge planning, identifying alternate treatment programs that provide medically necessary and potentially cost-effective services. The role consults with physicians, providers, members, and other resources to assess, plan, facilitate, coordinate, monitor, and evaluate options and services required to meet individuals’ health needs. The position uses communication and available resources to promote quality, cost-effective outcomes, serves as a liaison to physicians and members, and serves as a preceptor for less experienced staff. The role performs face-to-face visits in San Antonio and provides telephonic support for all other locations, with travel within the assigned location.

Requirements

Registered Nurse (RN) with a current, valid, unrestricted license in the state of operations or reciprocity.
At least 2 years of clinical experience providing direct clinical care to consumers.
At least 1 year of experience in health insurance or managed care.
Customer-service orientation.
PC proficiency, including Word, Excel, Lotus Notes, and database experience.
Clear and concise verbal and written communication skills.
Nurses in positions or departments requiring multistate licenses must obtain and maintain additional current, valid, unrestricted applicable nursing licenses in other states as determined by management.

Nice To Haves

3 years of clinical experience.
Experience in Disease Management.
Experience managing complex or catastrophic cases.
Working toward CM certification or an advanced degree.
Knowledge of medical management policies and procedures.
Bilingual in Spanish/English or Polish/English.

Responsibilities

Perform concurrent reviews in accordance with accepted department criteria.
Conduct discharge planning and identify alternate treatment programs that provide medically necessary and potentially cost-effective services.
Consult with physicians, providers, members, and other resources to assess, plan, facilitate implementation, coordinate, monitor, and evaluate options and services for individuals’ health needs.
Use communication and available resources to promote quality, cost-effective outcomes.
Serve as a liaison to physicians and members.
Serve as a preceptor for less experienced staff.
Perform face-to-face visits in San Antonio and provide telephonic support for other locations.
Travel within the assigned location.