Case Manager II RN

Job DescriptionJob Description

**Remote Hidalgo Area**

***MUST LIVE IN HIDALGO AREA***

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.

osition 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.

Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 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.
 

Walk me through the day to day responsibilities of this the role and a description of the project (Outside of Workday JD):

·       Transcribing of assessments and possibly follow ups with members, completing Task assigned

Describe the performance expectations/metrics for this individual and their team:

·       Provide support to medical, behavioral and social support staff to determine needs, eligibility and services for members.

·       Conduct screening and risk assessment interventions per program guidelines. Job Responsibilities: Identify special needs members through the completion of health screens and other resources.

·       Work with community outreach/member advocates to coordinate member care.

·       Educate providers and community resources on program components and available support services. Educate members with special needs to foster compliance with program and positively impact outcomes.

·       Assist with modification and management of care plans, medical consenter or caregiver, Department of Family and Protective Services (DFPS) caseworker and family, if applicable, as well as the managing physician

Tell me about what their first day looks like:

·       Centene training, Rug Training registration

What previous job titles or background work will in this role?

·       Education/Experience: Bachelor’s degree in Nursing or Associates degree in Nursing, Minimal experience. 1-2 years of experience Hospital/ Home Health.

Texas Requirements:
Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 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.
 

Company DescriptionMedia Riders Inc is a family-owned Recruitment and Staffing Services company. Providing recruitment and payroll services to our customers, who directly support State and/or Federal funded programs. We are an SBA certified Women-Owned Small Business (WOSB) and Texas certified Historically Underutilized Business (TxHub).Company DescriptionMedia Riders Inc is a family-owned Recruitment and Staffing Services company. Providing recruitment and payroll services to our customers, who directly support State and/or Federal funded programs. We are an SBA certified Women-Owned Small Business (WOSB) and Texas certified Historically Underutilized Business (TxHub).

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