RN Nurse Case Management Senior Analyst
1 month ago
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply
Our people make all the difference in our success.
Primary Function: Coordinate and manage relationships with participating provider practices.
Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a process to ensure all customers in participating provider practices meet all quality metrics.
Responsible for coordinating the delivery of cost-effective, quality –based health care services for health plan customers by development and implementation of alternative treatment plans that address individual needs of the customer, their benefit plan, and community resources.
Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan.
Utilizes clinical skills to assess, plan, implement, coordinates, monitor and evaluates options and services in order to facilitate appropriate healthcare outcomes for customers.
Responsibilities:
• Identifies gaps in needed quality metrics for customers and communicates to provider
• Maintains physical presence in participating provider practices
• Identifies high-risk/high-cost patients for possible case management intervention.
• Interfaces with providers of medical services and equipment to facilitate effective communication, referrals, development of discharge planning, and alternative treatment plan development.
• Identifies customer needs, coordinates and supports planned and unplanned transitions and post discharge follow up calls which may include primary care physician and specialist appointment scheduling
• Collaborates with the attending physician to achieve identified patient outcomes.
• Attend and participate in weekly Complete Health Team rounds
• Perform telephonic outreach or home visits, as needed
• Communicates with all departments to resolve issues or document trends.
• Understands and follows administrative guidelines (policy and procedure) of the unit.
• Attends and actively participates in staff meetings.
• Other Duties as assigned. Supervisory Responsibilities:
• None
Experience:
• Current Licensure as a Registered Nurse, in the state of Texas in good standing.
• Associates degree, diploma or B.S. in Nursing
• Three to Five (3-5) years recent experience in an acute-care environment, case-management or utilization management position (experience can be a combination of LVN/RN licensure)
• Previous HEDIS and/or CMS STARs experience a plus
Job Related Skills:
Verbal and written communication skills
• Interpersonal skills
• Basic Mathematical and statistical ability
• Organizational skills
• Typing and computer knowledge- able to type 35WPM
• Knowledge of utilization review requirements and procedures
• Knowledge of current health care practices and appropriate treatments.
• Knowledge of community resources
• Ability to travel to and work at participating provider offices
• Works independently with minimum of supervision
• Bilingual – preferred Spanish both conversational and written
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
-
RN Nurse Case Management Senior Analyst
1 week ago
Harlingen, Texas, United States Cigna Full timeRN Nurse Case Management Senior Analyst - Greater Mc Allen Texas/Upper Valley Area - Work Onsite at Providers OfficePrimary Function: Coordinate and manage relationships with participating provider practices.Maintain detailed understanding of HEDIS / STAR performance measures. Develop and maintain a process to ensure all customers in participating provider...
-
Billing Analyst
3 weeks ago
Harlingen, Texas, United States Harlingen Medical Center Full timeBilling AnalystFacilityPrime Healthcare Management IncLocationUS-TX-HarlingenID CategoryAdminPosition TypeFull TimeShiftDaysJob TypeNon-ExemptOverviewPrime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6...
-
Billing Analyst
1 month ago
Harlingen, Texas, United States Harlingen Medical Center Full timeBilling AnalystFacilityPrime Healthcare Management IncLocationUS-TX-HarlingenID CategoryAdminPosition TypeFull TimeShiftDaysJob TypeNon-ExemptOverviewPrime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6...
-
Harlingen, Texas, United States Baptist Health System - San Antonio TX Full timeBaptist Health System - San Antonio TX is seeking a Registered Nurse (RN) Labor and Delivery Director for a nursing job in Harlingen, Texas.Job Description & RequirementsSpecialty: Labor and DeliveryDiscipline: RNDuration: Ongoing36 hours per weekShift: 12 hoursEmployment Type: StaffSummary This role provides leadership and support to the senior executive...
-
Harlingen, Texas, United States Baptist Health System - San Antonio TX Full timeBaptist Health System - San Antonio TX is seeking a Registered Nurse (RN) Oncology for a nursing job in Harlingen, Texas.Job Description & RequirementsSpecialty: OncologyDiscipline: RNDuration: Ongoing36 hours per weekShift: 12 hoursEmployment Type: StaffUp to $20,000 Sign-On bonus for experienced Registered Nurse / RN SummaryThe Registered Nurse / RN...
-
Nights- Intake Clinician LMSW, LPC, or RN
1 week ago
Harlingen, Texas, United States Palms Behavioral Health Full timeNights- Intake Clinician LMSW, LPC, or RN | Palms Behavioral Health | Harlingen, Texas*About the Job: The Intake Clinician is a behavioral health professional responsible for facilitating admissions, clinical intake assessments and prior authorization process to assure continuity for the most appropriate level of care for patients. Performs assessments,...
-
Data Analyst I, Cross Reference
1 week ago
Harlingen, Texas, United States MSC Industrial Direct Full timeCome join our team and build a rewarding career at MSC Industrial Supply Co.!Are you ready to be part of a company that values its people and their dedication to delivering top-notch service to customers and the community? Look no further than MSC Industrial Supply Co., a trusted distributor of metalworking and maintenance, repair, and operations (MRO)...
-
Harlingen, Texas, United States Optum Full time$2,000 Sign-on Bonus Available for External Candidates For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. The Healthcare Manager is responsible for successfully supporting...
-
Registered Nurse
2 weeks ago
Harlingen, Texas, United States Mission Regional Medical center Full timeRegistered Nurse - Cath Lab Overview Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community Harlingen Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference. Harlingen Medical Center is a...
-
Nights- Intake Clinician LMSW, LPC, or RN
1 week ago
Harlingen, Texas, United States Palms Behavioral Health Full timeNights- Intake Clinician LMSW, LPC, or RN | Palms Behavioral Health | Harlingen, TexasAbout the Job:The Intake Clinician is a behavioral health professional responsible for facilitating admissions, clinical intake assessments and prior authorization process to assure continuity for the most appropriate level of care for patients. Performs assessments,...
-
Manager of Perioperative Services
1 week ago
Harlingen, Texas, United States Mission Regional Medical Center Full timeManager of Perioperative Services (RN)Overview Currently eligible for a $5,000 sign-on bonusHarlingen Medical Center, one of South Texas's best kept secrets, offers patients the best of both worldsa warm, caring environment, close to home while providing the wide range of services and expertise typically found in much larger facilities.Harlingen Medical...
-
Harlingen, Texas, United States Baptist Health System - San Antonio TX Full timeJob DescriptionBaptist Health System in San Antonio, TX is looking to hire a Registered Nurse (RN) specialized in Med Surg for a nursing position in Harlingen, Texas.Job DetailsSpecialty: Med SurgDiscipline: RNDuration: OngoingHours per week: 36Shift: 12 hoursEmployment Type: StaffPerks: Up to $20,000 Sign-On bonus for experienced Registered Nurses /...
-
Harlingen, Texas, United States Optum Full timeA partner of the Optum Care network, WellMed Medical Group is seeking an internal medicine or family medicine physician to join our clinic at Central Park in Harlingen, Texas.Opportunities 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...
-
Harlingen, Texas, United States Optum Full timeA partner of the Optum Care network, WellMed Medical Group is seeking an internal medicine or family medicine physician to join our clinic at Central Park in Harlingen, Texas.Opportunities 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...
-
Staff Nurse~ Cardiac Unit with sign on bonus
1 week ago
Harlingen, Texas, United States Baptist Health System - San Antonio TX Full timeBaptist Health System - San Antonio TX is seeking a Registered Nurse (RN) Cardiac Cath Lab for a nursing job in Harlingen, Texas. Job Description & Requirements ~ Specialty: Cardiac Cath Lab ~ Discipline:RN~ Duration: Ongoing ~36 hours per week ~ Shift: 12 hours ~ Employment Type: Staff Up to $20K Sign On Bonus based on experience Summary The Registered...
-
Intake Manager- Swing
1 week ago
Harlingen, Texas, United States Palms Behavioral Health Full timeIntake Manager- Swing (RN, LPC, or LMSW Required) | Palms Behavioral Health | Harlingen, Texas*About the Job:The Intake Manager is responsible for assisting the Director in managing all the different aspects of the patient assessment, referral, and admission process. Responsibilities include intake screenings for incoming patients, providing clinical...
-
Intake Manager- Swing
1 week ago
Harlingen, Texas, United States Summit BHC Full timeIntake Manager- Swing (RN, LPC, or LMSW Required) | Palms Behavioral Health | Harlingen, Texas About the Job: The Intake Manager is responsible for assisting the Director in managing all the different aspects of the patient assessment, referral, and admission process. Responsibilities include intake screenings for incoming patients, providing clinical...
-
Employee Health Non-RN
1 week ago
Harlingen, Texas, United States Harlingen Medical Center Full timeOverviewJoin an award-winning team of dedicated professionals committed to our core values of quality, compassion and community Harlingen Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference.Harlingen Medical Center is a Level IV Trauma Designated...
-
Registered Nurse
1 week ago
Harlingen, Texas, United States Prime Healthcare Full timeOverview Join an award-winning team of dedicated professionals committed to our core values of quality, compassion and community Harlingen Medical Center, a member of Prime Healthcare, offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference. Harlingen Medical Center is a Level IV Trauma...
-
Register Nurse
1 week ago
Harlingen, Texas, United States Golden Palms Rehabilitation and Retirement Full timeAre you craving to work in a healthcare setting where you're not only valued, but appreciated and have the respect from your supervisors and co- workers as well as patients/residents you're caring for? Then we are the place for you Register Nurse/Licensed Vocational Nurse (LVN) Hours: 6am-6pm or 6pm-6am Status: Full Time Texas RN license is required/Texas...
