Location : Remote and member facing
Source from the Austin area
SHIFT : 8 : 00- 5 : 00pm, possible overtime
Duration : 6+ month contract
Job Description : Position Purpose :
Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex / high acuity populations with primary medical / physical health needs to promote quality, cost effective care.
Develops a personalized care plan / service plan for long-term care members, addresses issues, and educates members and their families / caregivers on services and benefit options available to receive appropriate high-quality care.
Walk me through the day to day responsibilities of this the role and a description of the project :
Making phone calls to members for contractual outreaches, conducting in home visits with members. Assisting with various needs for member such as DME and waiver needs.
Describe the performance expectations / metrics for this individual and their team :
We utilized audits and spot checks to ensure appropriate usage of work processes.
Education / Experience :
Requires Graduate from an Accredited School or Nursing or a Bachelor's degree and 4 6 years of related experience
Bachelor's degree in Nursing preferred
License / Certification :
RN - Registered Nurse - State Licensure and / or Compact State Licensure required or
NP - Nurse Practitioner - Current State's Nurse Licensure required
For Client : Resource Utilization Group (RUG) certification required at time of hire.
Internal / External Groups with which the Candidate will interface :
Required Skills / Experience :
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.
Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.
e. Interqual, NCCN) and government sponsored managed care programs
Preferred Skills / Experience :
2+ years of clinical nursing or case management experience in a clinical, acute care, managed care or community setting.
2+ years experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment.
Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs. Other state specific requirements may apply.
Education Requirement :
Graduate from an Accredited School of Nursing
Education Preferred :
Bachelor s degree in nursing preferred
Software Skills Required :
Required Certifications :
Texas- Registered Nurse
Required Testing :
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