Case Mgr. Medicare Advantage Integrated, El Paso Health (RN or Licensed Social Worker)

El Paso Health • El Paso, TX

20h

About The Position

Ensures members with complex needs receive coordinated, integrated care across medical, behavioral, and community-based services. Serving members enrolled in both Medicare and Medicaid through El Paso Health, this position coordinates benefits across both programs while working with Primary Care Providers (PCPs), specialists, and other providers to remove barriers to care. Conducts screenings and assessments, develops and maintains person-centered Individual Service Plans (ISPs), and monitors services to ensure they remain appropriate and effective as member needs evolve. Serves as a member advocate, educating and assisting members, caregivers, medical consenters, and partner agencies, including Health and Human Services (HHHS) and Department of Family and Protective Services (DFPS), in navigating the healthcare system, accessing available services and supports, and understanding their rights throughout the process.

Requirements

• Current active and unrestricted license to practice as a Registered Nurse or Social Worker in the State of Texas.
• Bachelor degree in Nursing or Social Work.
• Three years of professional nursing or social work experience.
• Excellent verbal and written communication and interpersonal skills.
• Strong analytical, data management and computer skills.
• Able to work with people of all social, economic, and cultural backgrounds.
• Flexible, open-minded and adaptable to change.
• Understanding of pre-acute and post-acute venues of care and community resources.
• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients/families.
• Computer and typing skills required.

Nice To Haves

• Bilingual in English and Spanish.
• Previous experience as a Case Manager.
• Patient-Driven Payment Model (PDPM) for Long Term Care certification or Resource Utilization Group (RUG) certification (to be obtained within 90 days of hire).
• Certified Case Management (CCM).

Responsibilities

• Coordinate, integrated care across medical, behavioral, and community-based services for members with complex needs.
• Coordinate benefits across Medicare and Medicaid programs.
• Work with PCPs, specialists, and other providers to remove barriers to care.
• Conduct screenings and assessments.
• Develop and maintain person-centered Individual Service Plans (ISPs).
• Monitor services to ensure they remain appropriate and effective.
• Serve as a member advocate.
• Educate and assist members, caregivers, medical consenters, and partner agencies in navigating the healthcare system, accessing services, and understanding their rights.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level