RN Case Manager

GuideWell; Irving (TX); Remote; USD 80,000 - 100,000; Full time

Benefits offered by this job

Health insurance

Disability benefits

Paid time off

Retirement match

Wellness program

Job summary

GuideWell seeks an experienced RN Case Manager to develop, implement, and monitor treatment plans for members. You will analyze health needs, coordinate care with providers, and ensure quality care within cost containment guidelines.

Based in Irving, TX with remote options, this role emphasizes collaboration across teams and ongoing assessment of care plans to achieve patient-centered outcomes.

Qualifications

• 5+ years of clinical nursing experience with patient assessment.
• Bachelor’s degree or equivalent related experience.
• Graduate of an accredited school of nursing and RN licensure.
• Knowledge of medical terminology and cost containment practices.
• Ability to collaborate across organization functions.

Responsibilities

• Assess member health status and care coordination needs, including discharge planning.
• Coordinate contact with patient, family, physicians, and other providers.
• Identify alternative treatment plans within cost containment guidelines.
• Monitor health status and adjust care plans as needs change.
• Identify services and resources to promote timely, cost-effective care.
• Develop and implement short- and long-term Case Management goals.
• Evaluate cost-effectiveness of treatment plans and document outcomes.
• Report accurately to clients and stakeholders.
• Review medical records to determine medical necessity and authorize care.

Skills

RN Case Manager

Nursing experience

Patient assessment

Collaboration

Medical terminology

Education

Bachelor’s degree in related field

RN licensure

Graduate of accredited school of nursing

Job description

• Locations United States Irving, TX, United States (Remote)

Job Description

Get To Know Us!

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.

What is your impact?

The RN Case Manager primary responsibility is to create, implement, and monitor treatment plans to assist patients/members in meeting their healthcare goals. You would use knowledge of healthcare and social services to assess needs and provide interdisciplinary care options in treatment planning for the member. This would include understanding the member's healthcare benefits and healthcare best practices needed for effective treatment planning.

• Hours Monday to Friday ability to work 9a-6p CST or 10a-7p CST shift required

What Will You Be Doing:

• Case Management process includes assessing the member’s health status and care coordination needs. Can include inpatient review and discharge planning, as well as possible outpatient management.
• Contact with patient, family, physicians, additional health care providers, and community resources. Contact with provider business offices and with the employer/client may also be required.
• Identification of alternative treatment plans, which would have to be approved by all parties. These alternative care plans will be based on quality care within cost containment guidelines, allowing available claims dollars to be used in the most judicious manner possible.
• Assessment of the clinical status and resultant sequela to coordinate the most appropriate service to meet the individual’s health care needs. The Case Manager will then monitor the health status and the impact of the treatment plan for each client. The Case Manager will be responsible for altering the care plan as deemed appropriate by the dynamic, ever-changing client needs.
• Identification of services, resources, providers, and facilities that could best serve members in a timely and cost-effective manner, to promote optimum value for the client and reimbursement source.
• Development and implementation of Case Management goals, both short and long term, with documented care plans.
• Utilize technology/resources to evaluate the cost-effectiveness of the elected treatment plan, pre-implementation and post-implementation. This outcome measurement will be used in determining the effective results and in establishing future patient-centered care plans.
• Accurate and timely reporting as deemed appropriate by each client member.
• Medical record review to determine medical necessity of requested services.
• Interpreting individual health plans and authorizing/coordinating care in accordance with plan provisions.

What You Must Have:

• 5+ years related work experience with a professional background in clinical nursing and patient assessment.
• Related Bachelor’s degree or additional related equivalent work experience
• Graduate of an accredited school of nursing
• RN - Registered Nurse - State Licensure
• Knowledgeable in medical terminology, reasonable and necessary treatment plans, delivery quality health care services and cost containment practices.
• Ability to collaborate with cross-operational areas within the organization.

What We Prefer:

• (CCM) Certified Case Manager
• Prior experience in utilization management or case management preferred, preferably within the managed care environment
• Intensive care or higher-acuity patient experience preferred.
• Knowledge of managed care in a self-funded employer population is preferred.
• Ability to identify problems such as underutilization or overutilization of services
• Ability to promote and maintain quality care through analysis

What We Can Offer YOU!

To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance
• Income protection benefits: life insurance, Short- and long-term disability programs
• Leave programs to support personal circumstances
• Retirement Savings Plan includes employer contribution and employer match
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits available and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.

General Physical Demands:

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.