- Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care
- Utilize both company and community-based resources to establish a safe and effective case management plan for members
- Collaborate with patient, family, and healthcare providers to develop an individualized plan of care
- Identify and initiate referrals for social service programs; including financial, psychosocial, community, and state supportive services
- Manage care plan throughout the continuum of care as a single point of contact
- Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
- Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team
- Utilize approved clinical criteria to assess and determine appropriate level of care for members
- Document all member assessments, care plan and referrals provided
- Participate in Interdisciplinary team meetings and Utilization Management rounds and provide information to assist with safe transitions of care
- Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan
- Accountable to understand role and how it affects utilization management benchmarks and quality outcomes
- Expect to spend about 75% of your time in the field visiting our members in their homes or in long - term care facilities. You'll need to be flexible, adaptable and, above all, patient in all types of situations
- Current unrestricted RN license in the state of Texas
- 2+ years of experience working within the community health setting or in a health care role
- Familiarity with Microsoft Office, including Word, Excel, and Outlook
- Valid driver's license, reliable transportation and the ability to travel up to 75% in this 'assigned region' to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, nursing facilities or providers' offices
- High-speed internet at residence
- Reside within commutable driving distance to Richardson, TX and surrounding areas
- 1+ years of experience with long term care services and support, Medicaid or Medicare
- Ability to create, edit, save and send documents, spreadsheets and emails




