RN Case Manager: Expert Care Coordination & Outcomes

University Health Careers; Hondo (TX); On-site; USD 75,000 - 105,000; Full time

Job summary

Community First Health Plan (CFHP) seeks an experienced registered nurse to oversee care coordination and ensure access to services for members in Texas. The role emphasizes efficient resource allocation, quality of care, and collaboration with PCPs, family, and community resources.

Requirements include an active Texas RN license, BSN or Master's preferred, and at least four years in nursing or managed care.

Qualifications

• RN with current Texas licensure
• BSN or Master’s degree preferred
• Minimum four years nursing, acute care, quality management or managed care experience
• Knowledge of InterQual screening criteria and coding resources (DRG, ICD and CPT)
• Knowledge of Medicaid, community resources, Texas HHSC and TX Department of Insurance HMO standards and NCQA in a managed care setting

Responsibilities

• Oversee resource allocation, cost and quality of care for members.
• Coordinate care between the PCP, community resources, family and member.
• Coordinate care across the health care continuum while monitoring and managing benefit utilization.
• Collaborate with multi-disciplinary health care team members in identifying the educational and discharge needs of members.

Skills

Care coordination

Medicaid knowledge

Texas HHSC standards

NCQA in managed care

4+ years nursing/acute care/quality管理/

Education

BSN degree

Master’s degree

Tools

InterQual criteria knowledge

DRG coding

ICD coding

CPT coding

Job description

Community First Health Plan (CFHP) seeks an experienced registered nurse to oversee care coordination and ensure access to services for members in Texas. The role emphasizes efficient resource allocation, quality of care, and collaboration with PCPs, family, and community resources.

Requirements include an active Texas RN license, BSN or Master's preferred, and at least four years in nursing or managed care.