Case Manager/HP

Location:

Calmont Operations Building

Department:

Population Health Management

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Performs case management activities across the continuum of care in order to promote and facilitate quality, cost effective outcomes and minimize fragmentation of health care delivery for the assigned member population. The Health Plan Case Manager identifies and coordinates short and long term needs of catastrophically/chronically ill and/or injured children/adolescents and their families.

Additional Information:

Performs case management activities across the continuum of care in order to promote and facilitate quality, cost effective outcomes and minimize fragmentation of health care delivery for the assigned member population. The Health Plan Case Manager identifies and coordinates short and long term needs of catastrophically/chronically ill and/or injured children/adolescents and their families.

Education and Experience

• Associate degree in nursing. BSN from an accredited college or university is preferred.
• Three years of any combination of experiences working in/with case management, care coordination, utilization review, patient intake, discharge planning and troubleshooting fund resources, quality assurance, clinical pathways, continuous quality improvement, or state and federal health plans or commercial insurance plans in a clinical or managed care environment.
• Must be computer literate, and have effective organizational, interpersonal, written, and oral communication skills.
• Must be familiar with various community resources and charitable organizations.
• Must be able to adapt to changing healthcare environments and work with all members of the healthcare team to achieve positive outcomes.
• Must have experience using or navigating electronic medical records (e.g., EPIC, Meditech, Healthy Planet, etc.).
• Bilingualism is preferred or may be required depending on the specific department assignment.

• Current RN license from Texas Board of Nursing required
• Case Manager Certification (CCM) preferred.