- Analyze health care services and monitor outpatient care planning for Community First Health Plans members based on established criteria plan policies and procedures
- Formulate communicate case management plans that efficiently utilize healthcare services to move the member along the continuum of care towards optimum outcomes in the safest most cost-effective manner
- Identify areas where additional support can be provided to members through collaboration with internal stakeholders external partners
- Bachelor's degree Master's degree from an accredited school of professional nursing (BSN)
- Candidate must have minimum three years' acute experience or managed-care experience required: one year concurrent review Experience utilizing certification Case Management (CCM) designation Active RN license issued Board Nurse Examiners State Texas active Certified Registered nurse licensure supplemented certifications certification UM QA remains Compliance Background checks MVR check performed when necessary only Continuous QI training education advancement required maintaining Competency ESI No annual ongoing orientation reviews competency reports Based performance AND We require simultaneous verification records dates effective transferred source update Always P''ing Enterprise-system )
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Nurse Case Manager - Hondo - University Health
Description
Nurse Case Manager
We are seeking a highly skilled and experienced nurse case manager to join our team at University Health. In this role, you will play a critical part in providing high-quality care to our patients by identifying those with specific healthcare needs and developing personalized case management plans.
The ideal candidate for this position will have a strong background in acute care or managed care experience, as well as utilization management and quality assurance skills. Additionally, knowledge of Medicaid, community resources, alternate funding programs, InterQual screening criteria, DRG coding, ICD-9 coding and CPT coding is preferred.
Responsibilities:
Requirements:
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Nurse Case Manager
University Health- Hondo
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Nurse Case Manager
University Health- Hondo
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Nurse Case Manager
Part time University Health- Hondo
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Case Manager
Only for registered members Harlingen, TX
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Case Manager
Only for registered members Harlingen
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Case Manager--CLASS
Only for registered members Harlingen, TX
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RN Case Manager
Full time Only for registered members Harlingen
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Case Manager FAYS
Only for registered members Harlingen, TX
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Case Manager FAYS
Only for registered members Harlingen
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Lead Case Manager
Only for registered members Harlingen, TX
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Case Manager
Only for registered members Mercedes, TX
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Case Manager
Only for registered members Weslaco
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Case Manager
Only for registered members Weslaco, TX
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Case Manager
Only for registered members Donna, TX
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case manager
Full time Only for registered members La Villa
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Case Manager
Only for registered members Donna
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Case Manager
Only for registered members Brownsville, TX
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case manager
Only for registered members La Villa
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Assistant Lead Case Manager
Only for registered members Harlingen, TX
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Registered Nurse Case Manager
Full time Only for registered members Harlingen