RN Case Manager: Integrated Care Navigator

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

Job summary

Community First Health Plan in San Antonio, TX seeks a Registered Nurse to serve as a Care Manager, coordinating care across the health care continuum to improve outcomes and access to services. Required RN licensure in Texas with 4+ years in nursing or managed care; BSN or Master’s preferred.

Knowledge of InterQual criteria and DRG/ICD/CPT coding, Medicaid/HMO standards, and NCQA in managed care is essential.

Qualifications

• RN licensure in Texas is required.
• BSN or Master's degree preferred; four years nursing/acute care/managed care experience required.
• Knowledge of InterQual criteria and DRG/ICD/CPT coding.
• Knowledge of Medicaid, Texas HHSC, Texas D.I. HMO standards and NCQA in a managed care setting.

Responsibilities

• Oversee the allocation of resources, cost and quality of health care for CFHP 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 to identify educational and discharge needs.

Skills

InterQual criteria knowledge

DRG/ICD/CPT coding knowledge

Medicaid/HMO/NCQA knowledge

Care coordination experience

Education

BSN (preferred)

Master's degree (preferred)

RN licensure (Texas)

Job description

Community First Health Plan in San Antonio, TX seeks a Registered Nurse to serve as a Care Manager, coordinating care across the health care continuum to improve outcomes and access to services. Required RN licensure in Texas with 4+ years in nursing or managed care; BSN or Master’s preferred.

Knowledge of InterQual criteria and DRG/ICD/CPT coding, Medicaid/HMO standards, and NCQA in managed care is essential.