- Superior HealthPlan
- Mirando City, TX
Come and join Superior HealthPlan as a Care Manager RN - Foster Care. This hybrid position, a key role in the Medical Management/Health Services team, requires a Texas-based license and pediatric experience. As a critical member of this dynamic team, you will assess, plan, and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost-effective care, making a meaningful impact on millions of lives.
- Assess the member's current health status and resource utilization, and develop a plan of care based upon assessment with specific objectives, goals, and interventions to meet member's needs, promoting desired outcomes.
- Coordinate services between Primary Care Physician (PCP), specialists, and non-medical staff as necessary to meet complete medical socio-economic needs of clients.
- Provide patient and provider education and facilitate member access to community-based services.
- Monitor referrals to community-based organizations, medical care, and other services to support the members’ overall care management plan.
- Participate in integrated team care management rounds and identify related risk management quality concerns and report these scenarios to the appropriate resources.
- Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems.
- Review and approve the initial and ongoing assessment and care plan to ensure requirements are met.
- Facilitate member linkages to MCO-based services and programs in collaboration with agency staff and assist members and/or agency staff with transportation to healthcare appointments.
- Graduate from an Accredited School of Nursing with a current state’s RN license.
- Bachelor’s degree in Nursing preferred with 2+ years of clinical nursing experience and 1+ years of case management experience in a managed care setting.
- Knowledge of utilization management principles, healthcare managed care, medical decision support tools, and government-sponsored managed care programs is essential.
- Competitive salary range: $66,100.00 - $118,900.00 per year.
- Flexible work solutions including remote options, hybrid work schedules and dress flexibility.
- Paid time off including holidays and health insurance coverage for you and your dependents.
- 401(k) and stock purchase plans, tuition reimbursement, and best-in-class training and development.