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.
