Healthcare Case Manager RN
1 week ago
POSITION SUMMARY/RESPONSIBIILITIES The Service Coordinator Registered Nurse provides STAR Kids Members with initial and ongoing assistance by identifying, selecting, obtaining, coordinating, and using Covered Services and other supports to enhance the Member's well-being, independence, integration in the community, and potential for productivity. The SC-RN provides a holistic evaluation of the Member's individual dynamics, needs and preferences while providing education and health-related information to the Member, the Members Legal Authorized Representative (LAR), and the Members Support Network. Responsible for the coordination of STAR Kids members covered and non-covered services, including both acute and long term services and supports (LTSS), while meeting the Member's physical, behavioral, functional, and psychosocial needs. Complies with University Health Systems and CFHPs policies, procedures and protocols for establishing and maintaining good working relationships with co-workers, Health System employees, patients and guests. EDUCATION/EXPERIENCE BSN is preferred. Four (4) recent years of clinical experience preferred, which may include service coordination, case management, quality management or managed care experience. Working knowledge of ICD10, CPT4 coding, InterQual/M&R criteria, Texas Department of Insurance HMO standards, LTSS, and NCQA standards is preferred. Supervisory experience is preferred. LICENSURE RN must possess current licensure with the Texas State Board of Nurse Examiners. Current certification from an appropriate professional agency, such as the Case Management Society, is preferred.aa415a4b-8b21-40fc-a65c-70d2b25ca29a
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