Telephonic RN Case Manager {178063}

A-Line Staffing is now hiring Telephonic RN Care Managers in Texas. The Telephonic RN Care Manager will be working fully remote for a Fortune 500 managed care organization and has career growth potential. Candidates MUST reside in Texas and hold an active Texas RN license to be considered.

Compensation

• $40–$45 per hour, based on experience
• Benefits are available to full-time employees after 90 days of employment
• 401(k) with company match available for full-time employees after 1 year of service on eligibility dates

Highlights

• Fully remote position
• Must reside in Texas
• Monday–Friday, 8:00 AM–5:00 PM CST
• Supporting a Fortune 500 managed care organization
• Career growth potential

Responsibilities

• Provide support to medical, behavioral, and social support staff to determine member needs, eligibility, and appropriate services
• Conduct health screenings and risk assessments according to program guidelines
• Identify members with special needs through health screens and other available resources
• Coordinate member care with community outreach teams and member advocates
• Educate members, providers, and community resources on program components and available support services
• Educate members with special needs to encourage compliance and positively impact outcomes
• Assist with modifying and managing care plans in collaboration with members, caregivers, families, and managing physicians
• Follow up with members regarding coordination of care
• Follow up with providers and physicians' offices
• Maintain timely, accurate, and compliant documentation and assessments
• Support quality improvement and process improvement initiatives
• Monitor and improve performance related to UMR cases and audits
• Help improve overall member outcomes

Requirements

• Active RN license in the state of Texas
• Must reside in Texas
• 2+ years of clinical nursing experience in a clinical, acute care, or community setting
• 1+ year of case management experience in a managed care setting
• Knowledge of utilization management principles and healthcare managed care
• Knowledge of Medicare and Medicaid
• Experience with medical decision support tools such as InterQual or NCCN
• Experience with government-sponsored managed care programs
• Strong communication, documentation, organization, and care coordination skills

Preferred Qualifications

• Specialty Pharmacy experience highly preferred
• Experience with utilization management, care coordination, or complex case management
• Experience working with members with medical, behavioral, and/or social needs

If you think this Telephonic RN Care Manager position is a good fit for you, please apply to this posting!