Care Manager RN - San Antonio, TX - Full-time / Part-time

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)

• Collaborates effectively with interdisciplinary team to establish an individualized plan of care for members 


• The interdisciplinary team includes physicians, case managers, referral coordinators, pharmacists, social workers, and other disease educators


• Develops interventions to assist the member in meeting short and long term plan of care goals


• Assists management with oversight to care management functions and ensure compliance with application of criteria from approved standardized guidelines, government mandated regulations and contractual agreements, to include NCQA, URAC, and CMS


• Provide assessments of physical and psycho-social needs in settings not limited to the PCP office, hospital, or member's home


• Develops interventions and processes to assist the patient in meeting short and long term plan of care goals


• Coordinates and attends member visits with PCP and specialists as needed


• Physical Assessment Tasks may include taking of blood pressure, heart rate, respiratory assessment: Rate, effort, pulse oximetry, peripheral circulation and skin checks on exposed skin, foot checks for edema and skin integrity, home safety evaluation


• Fosters open communication with team members by acting as care management liaison and clinical resource in the implementation of strategic changes to corporate policies and projects to ensure smooth transition of operations


• Seeks ways to improve job efficiency and makes appropriate suggestions following the appropriate chain of command


• Stratifies and/or validates patient level of risk and communicates during transition process with IDT


• Performs all duties for internal and external customers in a professional and responsible manner having fewer than two complaints per year


• Enters timely and accurate data into designated care management applications and maintain audit scores of 90% or better on a quarterly basis


• Adheres to organizational and departmental policies and procedures
  
  
  
  • Takes on-call assignment as directed                      
  
  
  • Attends and actively participates in interdisciplinary team meetings as directed


• Mentors and serves as an operational resource for care management staff, PHC market providers, internal departments, and external partners regarding customer service issues


• Serves as a preceptor for onboarding employees and team members at local and regional levels


• Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
  
  
  
  • With the assistance of the Managed Care/UM teams, guides physicians in their awareness of preferred contracts and providers and facilities


• Attends educational offering to keep abreast of change and comply with licensing requirements and assists in the growth and development of associates by sharing knowledge with others


• Participates in the development of appropriate QI processes, establishing and monitoring indicators


• Performs all other related duties as assigned

• Education required:
  
  
  
  • Bachelor's degree in Nursing, or
  
  
  • Associate's degree in Nursing and Bachelor's degree in related field, or
  
  
  • Associate's degree in Nursing combined with 4+ years of experience


• Registered Nurse with current licensure to practice in the applicable state


• Case Management Certification (CCM)


• 3+ years of managed care and/or case management experience


• Diverse clinical experience with 5+ years of experience in caring for the acutely ill patients with multiple disease conditions


• Knowledge of utilization management, quality improvement, discharge planning, and cost management


• Possess planning, organizing, conflict resolution, negotiating and interpersonal skills


• Proficient with Microsoft Office applications including Word, Excel, and Power Point


• Independent problem identification/resolution and decision making skills


• Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously 

• Certified Diabetes Educator, or Certified Case Manager


• Experience working with psychiatric and geriatric patient populations


• Bilingual (English/Spanish) language proficiency