Regional Case Manager- Dallas, TX (21279)

Cantex Continuing Care Network•Carrollton, TX

1d•Onsite

About The Position

The Regional Case Manager (RCM) is responsible for directing and coordinating the care management process for Managed Care and ACO members across multiple Cantex facilities. This role ensures patients receive high‑quality, cost‑effective care by overseeing assessments, treatment planning, interdisciplinary collaboration, and ongoing review of clinical documentation. The RCM manages the continuum of care from admission through discharge, ensuring patients receive the right level of care at the right level of reimbursement. This position plays a key role in optimizing outcomes, supporting facility teams, and maintaining compliance with health plan requirements.

Requirements

Current, valid Texas nursing license (Registered Nurse or Licensed Vocational Nurse)
Strong communication, coordination, and delegation skills
Ability to read, interpret, and apply regulatory guidelines, clinical documentation, and health plan requirements
Ability to write reports, business correspondence, progress notes, and care coordination documentation
Ability to present information effectively to facility leadership, regional leadership, and senior leadership
Ability to communicate in English via phone, in writing, and verbally with staff, residents, families, and external partners
Ability to stand, walk, sit, reach, handle, or feel objects as needed
Ability to drive a personal vehicle to multiple facility locations
Ability to lift up to 50 pounds occasionally
Ability to use a computer, phone, and related technology for extended periods
Occasional exposure to facility environments, including noise, chemicals, and airborne particles
Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions

Nice To Haves

CCM certification preferred
At least 2 years of long‑term care or case management experience preferred

Responsibilities

Oversee and facilitate the coordination of care for Managed Care and ACO patients across assigned facilities
Lead and facilitate weekly IDT meetings for Managed Care and ACO members
Conduct regular onsite and offsite concurrent reviews of clinical, therapy, and social services documentation
Perform onsite reviews to ensure optimal reimbursement and compliance with health plan clinical terms
Ensure timely submission of all required documentation to health plans
Communicate with external Case Managers for all Managed Care patients
Share findings from onsite and offsite reviews with facility leadership and the Director of Managed Care
Assist with marketing efforts to health plan case managers and medical directors
Attend weekly facility Care Coordination Meetings to ensure compliance with federal and state reimbursement guidelines
Support training and orientation of new Patient Care Coordinators, Social Workers, and Therapy Managers
Collaborate with facility teams to achieve and exceed Managed Care budgeted rates
Coordinate patient satisfaction and service recovery efforts between the patient, facility, and health plan/ACO
Attend required in‑services and continuing education programs to maintain professional licensure and certification
Participate in ongoing education related to Medicare and Managed Care Case Management