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RN Care Manager

1 month ago

Lubbock, United States MRI Full time
Job DescriptionJob Description

** Remote, Must Live in Lubbock Area **

**Must have Hospital/ Home Health Experience**

Job Description

Qualified applicants must reside in Lubbock, Texas. This is a field-based role with up to 90% travel to visit members.

Position Purpose:
Develops, assesses and coordinates holistic care management activities, with primary focus and support towards the most complex or high risk/high acuity populations with primarily medical/physical health needs, to enable quality, cost-effective healthcare outcomes. Performs assessments, develops personalized care plans/service plans, and educates members, their families and caregivers on services and benefits available to meet member needs.

  • Evaluates the medical, behavioral and social needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome
  • Completes assessments related to medical/physical health needs such as airway management, artificial hydration/nutrition, seizure interventions, medication administration, etc., in addition to functional assessments and assessments of general health and social status
  • Acts as liaison and member advocate between the member/family, physician, and facilities/agencies. Performs more frequent home and/or other visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required
  • Supports members with complex medical needs that may place populations at greater risk for potentially preventable events, such as avoidable admissions, readmissions, and emergency room visits. (e.g., HIV/AIDS, cancer, COPD, hemophilia, sickle cell disease, brain injury)
  • Develops, monitors and modifies ongoing long-term care plans/service plans, to include skilled and/or long-term nursing service needs
  • Monitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicable
  • Ensures appropriate referrals based on individual member needs and supports the identification of providers, specialists, and community resources. Ensures identified services are accessible to members
  • Provides and/or facilitates education to long-term care members and their families/caregivers on topics such as preventive care, procedures, healthcare provider instructions, treatment options, referrals, prescribed medication treatment regimens, and healthcare benefits
  • Educates on and coordinates community resources, to include medical, behavioral and social services. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living)
  • Maintains accurate documentation and supports the integrity of care management activities in the electronic care management system; works to ensure compliance with clinical guidelines as well as current state and federal guidelines
  • Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
  • Performs other duties as assigned
  • Complies with all policies and standards

Education/Experience:

Requires Graduate from an Accredited School or Nursing or a Bachelor's degree and 2 – 4 years of related experience

License/Certification:

RN - Registered Nurse - State Licensure and/or Compact State Licensure required or NP - Nurse Practitioner - Current State's Licensure required

For Superior: Resource Utilization Group (RUG) certification required

 

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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