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Case Manager II

Location : Houston, TX (remote)
Job Type : Contract
Reference Code : 13050
Hours : Full Time
Required Years of Experience : 2-4
Required Education : Bachelor’s Degree in Nursing from an accredited nursing program
Travel : No
Relocation : No
Job Industry : Healthcare - Health Services
Job Category : Healthcare - Support Services

Job Description :

We are seeking a Remote Case Manager with an active, unrestricted Texas State RN license to join our team in the Houston, TX area! **PLEASE NOTE: This Candidates must have 2+ years of current or recent RN clinical experience, dependable transportation and valid auto insurance to complete face-to-face visits (once resumed) to be considered - no exceptions! STAR+PLUS and/or home health experience preferred.

Shift: Full-time 40 hrs/wk


 


Salary: up to $43/hr


 


Job Responsibilities: Identifies members with chronic or complex conditions that may qualify for potential case management services. Proactively provides case management services to qualified members by developing and implementing a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs. Performs ongoing monitoring, documentation and any necessary modifications of the plan of care to evaluate effectiveness and reach optimal outcomes by conducting face-to-face or home visits as required. Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for members. Assists orientation and mentoring of new team members as appropriate.




 


Required Qualifications :

Job Requirements: 


Knowledge of applicable state, and federal regulations, ICD-9, CPT coding, HCPC and SSI. Knowledgeable about Coordination of benefits, and Third Party Liability programs and integration. Familiarity with NCQA standards, state/federal regulations and measurement techniques. In-depth knowledge of CCA and/or other Case Management tools. Manages and completes assigned work plan objectives and projects in a timely manner. Attends regular staff meetings and participates in Interdisciplinary Care Team (ICT) meetings. Maintains professional relationships with provider community and internal and external customers. Participates in appropriate case management conferences to continue to enhance skills/abilities and promote professional growth.




Required Education:



  • Bachelor’s Degree in Nursing from an accredited nursing program


Required Experience:



  • 2-4 years of RN clinical experience with case management experience

  • Computer skills and experience with Microsoft Office Products

  • Excellent verbal and written communication skills


Required Licenses/Certifications:



  • Active, unrestricted TX State RN license

  • Valid State driver’s license


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