Care Manager RN - Foster Care

Job Description

Superior HealthPlan is seeking a Care Manager RN for Foster Care to perform care management duties focused on assessing, planning, and coordinating all aspects of medical and supporting services across the continuum of care. This role will promote quality, cost-effective care for select members. The ideal candidate must be licensed and reside in Texas, as this is a hybrid position with a specific service delivery area (SDA) that includes Garland, Rockwall, Mesquite, Forney, Terrell, Kaufman, Ennis, Corsicana, Waxahachie, and Wills Point areas.

Responsibilities

• Assess the member's health status, resource utilization, treatment plan, prognosis, and provider options.
• Develop a plan of care based on assessment, with specific objectives, goals, and interventions.
• Coordinate services between PCP, specialists, and non-medical staff.
• Provide patient and provider education, and facilitate member access to community-based services.
• Monitor referrals and actively participate in integrated team care management rounds.
• Identify related risk management quality concerns and report to appropriate resources.
• Enter and maintain assessments, authorizations, and clinical information into medical management systems.
• Direct care to participating network providers and demonstrate advanced understanding of complex care management principles.
• Review and approve assessments and care plans, and coordinate service request/authorizations.
• Facilitate member linkages to MCO-based services and programs, and assist with transportation to healthcare appointments.
• Participate in case management committees and weekly rounds with agency staff.
• Other duties as assigned.

Requirements

• Graduate from an Accredited School of Nursing with a current state’s RN license.
• Bachelor’s degree in Nursing preferred.
• 2+ years of clinical nursing experience, 1+ years of case management experience in a managed care setting, and knowledge of utilization management principles.
• Experience with medical decision support tools, government-sponsored managed care programs, and working with people with disabilities and vulnerable populations.

Benefits

• Competitive salary: $66,100.00 - $118,900.00 per year. Actual pay may be adjusted based on individual factors.
• Flexible work solutions, health insurance, 401K, stock purchase plans, tuition reimbursement, and comprehensive paid time off including holidays.