Nurse Case Manager II

SGS_JOB_2356

Nursing
 Texas
Case Management
Case Assessment
Nurse Case Manager
Case Manager

Contract - 06+ Months

Location : Denton, Flower Mound, Keller, Arlington, Mansfield & Fort Worth in TEXAS State Shift: M-F 8-5 This position is work from home and will require home visits and possible visits to Nursing Facility. Local travel with 50-75% of areas in Denton, Flower Mound, Keller, Arlington, Mansfield & Fort Worth in TEXAS State Candidate must reside in TX and area of coverage. Minimum 2 years of clinical experience. Able to travel 50-60% of their time to meet members face to face and surrounding counties/areas

Job Responsibilities:

  • Develop a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
  • Services strategies policies and programs are comprised of network management and clinical coverage policies.
  • Coordinates and implements assigned care plan activities and monitors care plan progress
  • Conducts multidisciplinary review to achieve optimal outcomes
  • Identifies and escalates quality of care issues through established channels
  • Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
  • Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
  • Provides coaching, information and support to empower the members to make ongoing independent medical and/or healthy lifestyle choices
  • Helps member actively and knowledgeably participate with their provider in healthcare decision-making
  • Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
  • Develop a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.
  • Services strategies policies and programs are comprised of network management and clinical coverage policies.
  • Coordinates and implements assigned care plan activities and monitors care plan progress
  • Conducts multidisciplinary review to achieve optimal outcomes
  • Identifies and escalates quality of care issues through established channels
  • Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs
  • Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
  • Provides coaching, information and support to empower the members to make ongoing independent medical and/or healthy lifestyle choices
  • Helps member actively and knowledgeably participate with their provider in healthcare decision-making
  • Monitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Skills:

  • Bi-Lingual Spanish/ English preferred
  • Bi-Lingual Spanish/ English preferred

Education/Experience:

  • RN with current unrestricted state licensure.
  • RN with current unrestricted state licensure.

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