Nurse Case Manager: Care Coordination Leader

University Health Careers; Boerne (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

University Health Careers is seeking a registered nurse in Boerne, TX to support CFHP members in obtaining necessary healthcare services efficiently. The role requires Texas RN licensure with 4+ years of nursing/acute care/quality or managed care, BSN/MSN preferred, and knowledge of InterQual criteria, DRG/ICD/CPT coding, Medicaid and NCQA standards. You will work with a multidisciplinary team to ensure proper discharge planning and coordinated care.

Qualifications

• RN license in Texas is required.
• BSN or MSN preferred; 4+ years in nursing, acute care, quality or managed care.

Responsibilities

• Oversee resource allocation, cost and quality of care for members.
• Coordinate care among providers, resources, family and members.
• Monitor benefit utilization and collaborate with multi-disciplinary team to address education and discharge needs.

Skills

InterQual screening criteria

DRG/ICD/CPT coding

Medicaid knowledge

Managed care experience

Education

RN licensure

BSN or MSN preferred

Job description

University Health Careers is seeking a registered nurse in Boerne, TX to support CFHP members in obtaining necessary healthcare services efficiently. The role requires Texas RN licensure with 4+ years of nursing/acute care/quality or managed care, BSN/MSN preferred, and knowledge of InterQual criteria, DRG/ICD/CPT coding, Medicaid and NCQA standards. You will work with a multidisciplinary team to ensure proper discharge planning and coordinated care.