Care Manager RN - Foster Care

Care Manager RN - Foster Care

Company: Superior HealthPlan

Job Type: Full-Time

Location: Hybrid position. SDA: Garland, Rockwall, Mesquite, Forney, Terrell, Kaufman, Ennis, Corsicana, Waxahachie, Wills Point areas

Salary Range: $66,100.00 - $118,900.00 per year

Superior HealthPlan is looking for a Care Manager RN with pediatric experience to perform care management duties to assess, plan, and coordinate all aspects of medical and supporting services for select members to promote quality, cost-effective care. This role entails assessing current health status, resource utilization, treatment plans, and services, as well as developing care plans with specific objectives, goals, and interventions. The ideal candidate will facilitate member access to community-based services, monitor referrals to support overall care management, and actively participate in integrated team care management rounds. Additional responsibilities include coordinating service request/authorizations, participating in case management committees, and acting as a single point of contact for overall care management activities.

Responsibilities

• Assess the member's current health status, resource utilization, treatment plan and services, and prognosis
• Coordinate services between medical providers and non-medical staff to meet the complete medical socio-economic needs of clients
• Provide patient and provider education and facilitate member access to community-based services
• Participate in integrated team care management rounds and identify related risk management quality concerns
• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
• Review and approve the initial and ongoing assessment and care plan to ensure requirements are met
• Coordinate service request/authorizations with UM and ensure agreement is aligned between the member, agency, and MCO
• Facilitate member linkages to MCO-based services and programs in collaboration with agency staff
• Assist members and/or agency staff with transportation to healthcare appointments
• Communicate status of member health indicators with agency staff to contribute to the successful community living of members
• Participate in weekly rounds with agency staff

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. Current state’s RN license is required.

Requirements

• Graduate from an Accredited School of Nursing, with a preference for a Bachelor’s degree in Nursing
• 2+ years of clinical nursing or case management experience in a clinical, acute care, managed care, or community setting
• 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
• Current state’s RN license

Benefits

• Flexible work solutions, including remote options, hybrid work schedules, and dress flexibility
• Competitive pay
• Paid time off, including holidays
• Health insurance coverage for you and your dependents
• 401(k) and stock purchase plans
• Tuition reimbursement and best-in-class training and development