RN Case Manager

Role : Clinical - Care Manager II (RN)

Location : Remote Role - TX

Duration : 3 to 6+ Months Assignment (With high possibility of extension and Conversion to FTE)

Hiring for the Below Service Delivery Area and their respective counties

• Dallas SDA : Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, and Rockwall
• El Paso SDA : Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Pecos, Presidio
• Lubbock SDA : Carson, Crosby, Deaf Smith, Floyd, Garza, Hale, Hockley, Hutchinson, Lamb, Lubbock, Lynn, Potter, Randall, Swisher, Terry
• Hidalgo SDA : Cameron, Duval, Hidalgo, Jim Hogg, Maverick, McMullen, Starr, Webb, Willacy, Zapata
• Harris SDA : Austin, Brazoria, Fort Bend, Galveston, Harris, Matagorda, Montgomery, Waller, Wharton
• Remote Home Based Role - Member visits are within 2 hour range of Employees home.
• Looking for candidates in above any of mentioned county.
• Will be conducting face to face visits in nursing facilities or may at member’s home.

Walk me through the day to day responsibilities :

• Gathering member information using our Electronic Medical Record system, reviewing diagnosis, medications, and recent authorizations in preparation for visits.
• Conducting various types of visits, including Initial, Change in Condition, MDCP, and Level 3 reassessments.
• Scheduling and completing assessments promptly based on leadership-provided reports, ensuring timely visit documentation.
• Ensuring member safety, satisfaction, and compliance by completing all in-person assessments, mandatory trainings, and additional outreaches on time.
• Traveling to member homes / facilities for in-person visits lasting 2-4 hours, with travel time of up to 2 hours one way.
• Submitting assessments within 24 hours and initiating service requests within 3 business days, with all other documentation due within 5 business days.

Handing off members to permanent care managers / service coordinators after 15 business days.

• Completing assigned tasks within specified turnaround times.
• Making necessary follow-up attempts, collaborating with nursing facility staff to ensure member safety, fulfill member needs, and achieve member satisfaction to meet compliance and contractual requirements.

Position Purpose :

Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care

• Develop, assess and adjust, as necessary, the care plan and promote desired outcome
• Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
• Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
• Develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
• Provide patient and provider education
• Facilitate member access to community based services
• Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
• Actively participate in integrated team care management rounds
• Identify related risk management quality concerns and report these scenarios to the appropriate resources
• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems

Education / Experience :

• Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred.
• 2+ years of pediatric clinical nursing experience in a clinical, acute care, or community setting.
• Knowledge of healthcare and managed care preferred. Florida residency required.
• Knowledge of healthcare and managed care preferred.
• Prior experience working in a remote role preferred.
• Prior case management experience preferred.

Licenses / Certifications : Current state’s RN license.

EEO : Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority / Gender / Disability / Religion / LGBTQI / Age / Veterans.