Manager of Care Management

2 weeks ago

Dallas TX, United States American Health Partners Full time

TruHealth is a division of American Health Partners, a multifaceted company with operations in multiple states. We own nursing homes, health plans for Medicare beneficiaries living in long-term care facilities, as well as divisions offering psychiatric care, home health, hospice, rehabilitation and specialty pharmacy services.
We believe in caring for the people that care for patients and have many reward and recognition programs to highlight the awesome and important work our clinicians do each and every day.
The RN Case Manager is primarily responsible for the daily management and support of the Case Management strategies for care coordination for a group of members who are associated with a Medicare Advantage plan. Visit (in person and/or telephonic) patients to ensure proper nursing care. Interview or correspond with physicians to correct errors or omissions and to investigate questionable claims. Consult and coordinate with health care team members to assess, plan, implement and evaluate patient care plans.
This position requires an individual who is a self-starter and team player, has the ability to manage multiple priorities, work with minimal supervision on assigned projects and activities, and demonstrates excellent communication and presentation skills. Annual performance wage increases
* 401k retirement plan with a company match
* Medical, dental and vision insurance
* $Holiday pay
* Telehealth through 98point6 - free to all employees
* Minimum of 2 years of experience in clinical nursing or rehabilitation for the geriatric population.
* 2-years managed care experience required.
* Minimum of 3-5 years' experience doing case management in a managed care environment preferably with a managed care organization or like facility, Preferred.
Complete Health Risk Assessments for members as assigned.
* Initiate, update and/or revise care plans as needed.
* Evaluates, coordinates, and plans patient care in collaboration with an interdisciplinary health team; reassesses and revises plans of care in collaboration with other members of the health care team.
* Provides education based on identified learning needs utilizing available teaching resources to members of the Home/Facility staff as needed.
* Participates in all Managed Care related audits; generates, maintains and tracks periodic and annual reports/documents via MS Office program, e-mails to support Care Coordination program.
* Performs improvement projects involving development of monitoring/collection tools, review of medical records, data entry, analysis, and preparation of audit findings and reports.
* Participates in patient care conferences, committee meetings, staff development and educational programs to increase or maintain professional competency.
* Correctly applies medical management criteria.
* Educate members on health access options.
* Responds, manages, and resolves day-to-day problems presented in care coordination and communicates effectively with the Facility/Home.
* Graduate of an accredited RN program.
* Bachelor's Degree preferred.
Current license to practice as a register nurse in assigned state.
* CPR for Healthcare Professionals certification.
*

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