Nurse Case Manager to assist members in understanding and utilizing health benefits, disease process and physician plan of care to achieve and maintain optimal health status.
• Assesses patient's health status & recommend appropriate care based on clinical judgment and protocols
• Adheres to ethical, legal/regulatory and accreditation standards
• Assesses consumer's understanding of their condition and identifies potential care and/or provider gaps
• Provides health education and coaches consumers on treatment alternatives to assist them in best decision making
• Assesses readiness to change, offering opportunities for intervention that will assist consumers in reaching their health care goals
• Supports consumers in selection of best physician and facility to maximize access, quality, and to manage heath care cost
• Empowers consumers with skills to enhance their interaction with their provider
• Coordinates services and referrals to health programs and community services
• Assesses and triages immediate health concerns
• Manages utilization through education
• Collaboratively plan care with member
• Document in and maintain legal medical records
• Communicate in writing the patient’s history, condition, plan of care and goals.
• Current, unrestricted RN licensure in the State of Texas; Bachelor's degree in Nursing (BSN) is required
• 2+ years of experience as a RN (Hospital, Clinical, Call Center, Physician's Office) working directly with customers/patients
• Ability to navigate a Windows based environment and create, edit, save and send documents utilizing Microsoft Word and Excel. Ability to navigate Outlook and conduct Internet searches.
• Proficiency with navigating multiple computer programs simultaneously while talking on the phone.
• Ability to understand readiness for change and ability to move members along the continuum of change
• Ability to work independently toward established priorities and goals
• Coaching, motivational interviewing and/or decision support experience
• Previous experience in a telephonic role is a plus
• Bilingual fluency with English and Spanish is a plus
Qualified applicants are considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.