Nurse Case Manager II

SGS Consulting; Austin (TX); On-site; USD 75,000 - 95,000; Full time

Job summary

SGS Consulting in Texas seeks a registered nurse with an active license to support member wellness through care coordination and collaborative provider engagement. The role focuses on care plans, monitoring outcomes, and promoting healthy lifestyle changes.

The ideal candidate is bilingual (Spanish/English), has RN licensure, and experience in case management or care coordination, with strong documentation and compliance skills.

Qualifications

• Bi-Lingual Spanish/ English preferred.
• RN with current unrestricted state licensure.
• Experience in case management or care coordination may be advantageous.

Responsibilities

• Develop proactive care plans to improve short and long-term member wellness.
• Coordinate care plan activities and monitor progress.
• Conduct multidisciplinary reviews to optimize outcomes and address quality issues.
• Engage members using motivational interviewing to support healthy lifestyle changes.
• Document care actions and ensure compliance with regulatory guidelines.

Skills

Bi-Lingual Spanish/ English

Education

RN with current unrestricted state licensure

Job description

Job Responsibilities:

Develop a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration.Services strategies policies and programs are comprised of network management and clinical coverage policies.Coordinates and implements assigned care plan activities and monitors care plan progressConducts multidisciplinary review to achieve optimal outcomesIdentifies and escalates quality of care issues through established channelsUtilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needsUtilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of healthProvides coaching, information and support to empower the members to make ongoing independent medical and/or healthy lifestyle choicesHelps member actively and knowledgeably participate with their provider in healthcare decision-makingMonitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and proceduresDevelop a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration.Services strategies policies and programs are comprised of network management and clinical coverage policies.Coordinates and implements assigned care plan activities and monitors care plan progressConducts multidisciplinary review to achieve optimal outcomesIdentifies and escalates quality of care issues through established channelsUtilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needsUtilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of healthProvides coaching, information and support to empower the members to make ongoing independent medical and/or healthy lifestyle choicesHelps member actively and knowledgeably participate with their provider in healthcare decision-makingMonitoring, Evaluation and Documentation of Care: Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Skills:

Bi-Lingual Spanish/ English preferredBi-Lingual Spanish/ English preferred

Education/Experience:

RN with current unrestricted state licensure.RN with current unrestricted state licensure.