Case Manager RN
1 month ago
Get To Know Us
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.
What is your impact?
The RN Case Manager primary responsibility is to create, implement, and monitor treatment plans to assist patients/members in meeting their healthcare goals. You would use knowledge of healthcare and social services to assess needs and provide interdisciplinary care options in treatment planning for the member. This would include understanding the member's healthcare benefits and healthcare best practices needed for effective treatment planning.
What Will You Be Doing:
The essential functions listed represent the major duties of this role, additional duties may be assigned.
Case Management process includes assessing the member's health status and care coordination needs. Can include inpatient review and discharge planning, as well as possible outpatient management. (10%)Contact with patient, family, physicians, additional health care providers, and community resources. Contact with provider business offices and with the employer/client may also be required. (10%)Identification of alternative treatment plans, which would have to be approved by all parties. These alternative care plans will be based on quality care within cost containment guidelines, allowing available claims dollars to be used in the most judicious manner possible. (10%)Assessment of the clinical status and resultant sequela to coordinate the most appropriate service to meet the individual's health care needs. The Case Manager will then monitor the health status and the impact of the treatment plan for each client. The Case Manager will be responsible for altering the care plan as deemed appropriate by the dynamic, ever-changing client needs. (10%)Identification of services, resources, providers, and facilities that could best serve members in a timely and cost-effective manner, to promote optimum value for the client and reimbursement source. (10%)Development and implementation of Case Management goals, both short and long term, with documented care plans. (10%)Utilize technology/resources to evaluate the cost-effectiveness of the elected treatment plan, pre-implementation and post-implementation. This outcome measurement will be used in determining the effective results and in establishing future patient-centered care plans. (10%)Accurate and timely reporting as deemed appropriate by each client member. (10%)Medical record review to determine medical necessity of requested services. (10%)Interpreting individual health plans and authorizing/coordinating care in accordance with plan provisions. (10%)What You Must Have:
5+ years related work experience with a professional background in clinical nursing and patient assessment. Related Bachelor's degree or additional related equivalent work experience Graduate of an accredited school of nursing RN - Registered Nurse - State Licensure and/or Compact State Licensure in good standing.Knowledgeable in medical terminology, reasonable and necessary treatment plans, delivery quality health care services and cost containment practices.Computer skills.Ability to collaborate with cross-operational areas within the organization.Good verbal and written communication skills.Ability to work as a team member, effectively and collaboratively, with non-clinical teammates.Adherence to ethical, legal and accreditation/regulatory standards.Maintaining client's privacy, confidentiality and safety as well as acting as an advocate for the covered member.Ability to travel is approximately 10% of the time is required.What We Prefer:
Prior experience in utilization management or case management preferred, preferably within the managed care environmentIntensive care or higher-acuity patient experience preferred. Proficiency in maintaining good rapport with other staff members, physicians, health care facilities, clients, and providers. Knowledge of managed care in a self-funded employer population is preferred. Ability to identify problems such as underutilization or overutilization of services Ability to promote and maintain quality care through analysisWhat We Can Offer YOU
To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to:
Medical, dental, vision, life and global travel health insuranceIncome protection benefits: life insurance, Short- and long-term disability programsLeave programs to support personal circumstancesRetirement Savings Plan includes employer contribution and employer matchPaid time off, volunteer time off, and 11 holidaysAdditional voluntary benefits available and a comprehensive wellness programEmployee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.
General Physical Demands:
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.
We are an Equal Opportunity Employer/Protected Veteran/Disabled.-
RN, Registered Nurse Care Manager
1 week ago
Irving, Texas, United States Christus Health Full timeSummary:The RN Care Manager (CM) II works with physicians and multidisciplinary team members to develop a plan of care for each assigned patient from admission through discharge. The CM ensures that the patient is progressing toward desired outcomes by continuously monitoring patient care through assessments and/or evaluations. Assesses and responds to...
-
Travel Nurse RN
2 weeks ago
Irving, Texas, United States MedPro Healthcare Staffing Full timeMedPro Healthcare Staffing is seeking a travel nurse RN Case Management for a travel nursing job in Irving, Texas.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: 06/17/2024Duration: 13 weeks36 hours per weekShift: 9 hours, daysEmployment Type: TravelMedPro Healthcare Staffing, a Joint Commission-certified staffing agency, is...
-
Home Health RN Clinical Manager
1 month ago
Irving, Texas, United States HCA Healthcare Full timeDescription IntroductionWant to join a team of daring managers who care without reservations or limits? Our Medical City Healthcare at Home team is looking for a(an) Home Health RN Clinical Manager. HCA Healthcare is an advanced healthcare network that has committed up to 300 million to our incredible team members over the course of three...
-
Home Health RN Clinical Manager
4 weeks ago
Irving, Texas, United States HCA Healthcare Full timeDescription IntroductionWant to join a team of daring managers who care without reservations or limits? Our Medical City Healthcare at Home team is looking for a(an) Home Health RN Clinical Manager. HCA Healthcare is an advanced healthcare network that has committed up to 300 million to our incredible team members over the course of three...
-
Director Care Management
1 month ago
Irving, Texas, United States Christus Health Full timeDescriptionSummary:Under the direction of the VP Network Operations, the Director of Care Management is directly responsible for the development, management, and oversight of Care Management and Post-Acute functions for Population Health, CHRISTUS Health Quality Care Alliance (ACO), and CHRISTUS Quality Network (CIN). The Director ensures professional and...
-
Director Care Management
4 weeks ago
Irving, Texas, United States Christus Health Full timeDescriptionSummary:Under the direction of the VP Network Operations, the Director of Care Management is directly responsible for the development, management, and oversight of Care Management and Post-Acute functions for Population Health, CHRISTUS Health Quality Care Alliance (ACO), and CHRISTUS Quality Network (CIN). The Director ensures professional and...
-
Program Director Care Management
1 week ago
Irving, Texas, United States CHRISTUS Health Full timeSummary:The Program Director of Care Management is responsible for providing consultative, educational development, and support services to the acute care facilities and affiliated networks in areas of clinical excellence; case management, and improved operational efficiencies. In addition, this position will serve as a content expert for the development of...
-
Program Director Care Management
1 month ago
Irving, Texas, United States Christus Health Full timeDescriptionSummary:The Program Director of Care Management is responsible for providing consultative, educational development, and support services to the acute care facilities and affiliated networks in areas of clinical excellence; case management, and improved operational efficiencies. In addition, this position will serve as a content expert for the...
-
Director Care Management
2 weeks ago
Irving, Texas, United States Christus Health Full timeSummary:Under the direction of the VP Network Operations, theDirector of Care Management is directly responsible for thedevelopment, management, and oversight of Care Management andPost-Acute functions for Population Health, CHRISTUS Health QualityCare Alliance (ACO), and CHRISTUS Quality Network (CIN). TheDirector ensures professional and consistent...
-
RN Field Based Supportive Care Nurse
4 weeks ago
Irving, Texas, United States Optum Full timeOpportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you...
-
RN Field Based Supportive Care Nurse
4 weeks ago
Irving, Texas, United States Optum Full timeOpportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you...
-
Agile Program Manager
1 week ago
Irving, Texas, United States Resource Informatics Group Full timeJob Title: - Agile Program Manager Location: - Houston Texas Hybrid - Tuesday, Wednesday, Thursday in the office) - Locals Needed Duration: - 6+ months Experience: - 13+ yearsSkills:Works directly with technical experts across IT competencies like Data Science, Cyber Security, Operational Technology like automation and high-performance computing. Need oil...
-
Home Health RN
4 weeks ago
Irving, Texas, United States HCA Healthcare Full timeDescription IntroductionWe are looking for a Home Health RN to cover the Ft. Worth, Grapevine, Arlington and Irving areas. Do you have the career opportunities as a Home Health RN you want with your current employer? We have an exciting opportunity for you to join Medical City Healthcare at Home which is part of the nations leading provider of healthcare...
-
Home Health RN
1 month ago
Irving, Texas, United States HCA Healthcare Full timeDescription IntroductionWe are looking for a Home Health RN to cover the Ft. Worth, Grapevine, Arlington and Irving areas. Do you have the career opportunities as a Home Health RN you want with your current employer? We have an exciting opportunity for you to join Medical City Healthcare at Home which is part of the nations leading provider of healthcare...
-
Assistant Project Manager
2 weeks ago
Irving, Texas, United States Crossfire Consulting Full timeTargeted Years of Experience: 2-5 years Responsibilities:" Assist Construction Project Managers with the overall completion and financial outcome of construction projects." Review funding requirements and submissions against Plan of Record" Manage all project financial activity in the Telecommunication finance systems, including but not limited to the...
-
RN Float Pool ICU
1 month ago
Irving, Texas, United States HCA Healthcare Full timeDescription IntroductionMedical City Healthcare is committed to investing in the latest technology enabling nurses to work more efficiently. Are you passionate about delivering patient-centered care? Submit your application for RN Float Pool ICU position and spend more time at the bedside with the patient.Facilities in West Pod: Alliance, Arlington, Las...
-
RN Float Pool ICU
4 weeks ago
Irving, Texas, United States HCA Healthcare Full timeDescription IntroductionMedical City Healthcare is committed to investing in the latest technology enabling nurses to work more efficiently. Are you passionate about delivering patient-centered care? Submit your application for RN Float Pool ICU position and spend more time at the bedside with the patient.Facilities in West Pod: Alliance, Arlington, Las...
-
Partner Management Mgr
2 weeks ago
Irving, Texas, United States Citigroup Inc. Full timeResponsibilities:- Develop and implement short and long-term strategies for a vast partner portfolio to ensure financial objectives are met.- Participate in cross-functional teams to execute key portfolio strategies and achieve profitability targets.- Assist in developing plans and forecasting metrics across different products.- Drive alignment of strategy...
-
Program Manager Patient Safety Nurse
2 weeks ago
Irving, Texas, United States Christus Health Careers Full timeSummary: The Program Manager Patient Safety Nurse Health Plan will work in collaboration with the Manager of Health Plan Quality to assist in consistent development of the patient safety program according to contractual and accreditation requirements, review and assess patient safety medical record reviews and prepare summaries for the Medical Director and...
-
Leave Management Specialist II
1 week ago
Irving, Texas, United States Christus Health Full timeJob Title: Leave Management Specialist IICompany: CHRISTUSSummary:As a Leave Management Specialist II at CHRISTUS, you will be integral in managing and facilitating leave processes, acting as a liaison between associates, management, HR, and third-party administrators. Your role involves ensuring compliance with company policies, state, and federal laws...
