RN Complex Care Manager for Chronic & High-Risk Conditions

Harris Health System, Inc.; Houston, Northern (TX, KY); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Community Health Choice, Inc. is seeking a Complex Case Manager (CCM) to identify, monitor, and optimize care for members with chronic, medically complex conditions across acute and non-acute settings.

The CCM will coordinate with PCPs, specialists, and other providers, performing telephonic assessments to create individualized care plans and discharge plans while authorizing services and ensuring data accuracy in the managed care platform.

Qualifications

• Registered Nurse with Texas license and current unrestricted status; CCM required or to be obtained within 18 months.
• Five years of clinical experience in an acute care setting; at least two years in a managed care/insurance environment.
• Proficiency with Microsoft Office (Word, Excel, Outlook).
• Excellent written and verbal communication; strong public contact skills.
• Ability to travel using a personal car as needed.

Responsibilities

• Identify, monitor, manage, and evaluate care for members with chronic/complex conditions in acute and non-acute settings.
• Coordinate care involving member, PCP, specialists and other providers.
• Perform telephonic assessments and create individualized care plans and discharge needs assessments.
• Authorize services at all levels of care and ensure data entry in the managed care platform.
• Refer to community health workers and disease management teams; coordinate with medical directors.
• Meet required performance and quality metrics and ensure compliance with regulations.

Skills

Analytical

Medical Terms

MS Word

Communication Skills

Education

RN license (Texas)

CCM certification or eligibility within 18 months

Tools

Microsoft Office

Job description

Community Health Choice, Inc. is seeking a Complex Case Manager (CCM) to identify, monitor, and optimize care for members with chronic, medically complex conditions across acute and non-acute settings.

The CCM will coordinate with PCPs, specialists, and other providers, performing telephonic assessments to create individualized care plans and discharge plans while authorizing services and ensuring data accuracy in the managed care platform.