Universal American
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RN Nurse Case Manager

Job Title
RN Nurse Case Manager
Job ID
994382
Begin Date
4/26/16
Duration
Location
Houston,  TX
Other Location
Description

Does TexanPlus® sound familiar? If yes, that is because you recognize our Medicare Advantage health plan, TexanPlus HMO. Throughout Texas, TexanPlus is highly regarded by providers, case managers, and Medicare recipients alike. In fact, TexanPlus HMO has earned a 4-Star Quality Rating, which is out of 5 for 2014 and 2015 fiscal year, from the Centers for Medicare and Medicaid Services which makes TexanPlus one of the highest rated Medicare plans in Beaumont and Houston area. In order to meet the needs of our members we serve, we are looking for versatile clinical Registered Nurses with expertise in case management, disease management, utilization review, and pre-certification to join our dynamic team. Universal American has an exciting opportunity for a RN Case Manager for our Dual Special Needs Population (D-SNP). This position is remote and the RN Case Manager will be required to travel 25% of the time. The RN Nurse Case Manager role is extremely dynamic. This role focuses on helping geriatric and disable members improve their physical, mental, functional, behavioral, and psychosocial status. The goal is help member's achieve timely and desirable health outcomes, which in turn, lead to greater member empowerment, healthcare satisfaction and independence. By taking this approach, we anticipate increased

1) compliance with treatment plans and medication adherence,
2) awareness and participation in annual preventative health screenings,
3) use of State, County, Health Plan, and community-based resources,
4) collaboration, transparency and coordination of care amongst members, families, caregivers, and healthcare professionals,
5) ongoing reconciliation on lifestyle and or disease-specific conditions, and
6) smoother transitions of care from inpatient/outpatient settings to home. In the end, the RN Nurse Case Manager will aid our members in achieving optimal health and well being.

Responsibilities The RN Nurse Case Manager will be responsible for the following care coordination activities:

  • Completes assessments on members as required for care management.
  • Manages the member's Individualized Care Plans (ICP) and coordinates the Interdisciplinary Care Team (ICT) meetings, agendas and activities.
  • Performs home visits and hand on assessments when required.
  • Coordinates and collaborates member's needs with providers, community agencies, and medical management teams.
  • Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS), regulatory agencies and Universal American departmental policies
  • Participates in training and professional development and willingly performs all other duties assigned by the Medical Management manager.

Required Skills The RN Case Manager must possess the ability to:

  • Communicate effectively in verbal and written forms
  • Execute departmental processes, multitask and complete time-sensitive assignments
  • Provide excellent and timely customer service to our geriatric and disable members, providers, third party vendors, physicians, and internal staff
  • Prioritize, analyze, investigate, and interpret data
  • Think critically and identify the root causes and implementable, workable solutions
  • Demonstrate a high degree of time management, cultural awareness, fidelity, interpersonal skills, flexibility, organization, adaptability and attention to detail
  • Work in fast pace environments

Additional Requirements:

  • RN with current Texas licensure
  • Valid driver's license (travel is required for on-site and home visits when applicable)
  • Two years of acute care and case management experience within clinics, hospitals, home health agencies or managed care settings (required)
  • Intermediate Microsoft Word, Excel, PowerPoint, and Outlook (required); comfortability using various applications, systems, databases, computers and communication platforms

Work Environment / Physical Demands Work is performed in a professional office setting and the environment is business casual. Please note that working extended hours may also be required on an as needed basis. The physical demands for this position include exerting up to 10 pounds of force occasionally, and or a negligible amount of force frequently to lift, carry, push, and pull or otherwise move objects, including the human body. This is considered sedentary work, which involves sitting for long periods of the; walking and standing on occasion. The ability to multitask is essential as, telephonic and data input is completed routinely. Reasonable accommodations will be made to individuals with disabilities so they will be able to perform essential job duties and functions.

Required Skills

RN License
Openings
1

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