Care Manager RN - Foster Care

Job Description

Superior HealthPlan is seeking a Care Manager RN for Foster Care to join our Medical Management/Health Services team. This hybrid position requires a candidate with pediatric experience, based in Texas. As a Care Manager RN, you will perform care management duties to assess, plan, and coordinate all aspects of medical and supporting services for select members, promoting quality and cost-effective care. You will have the opportunity to make a significant impact on the lives of our members and their families, playing a crucial role in their overall well-being.

Responsibilities

• Assess the member's current health status, resource utilization, past and present treatment plan and services, and prognosis.
• Coordinate services between Primary Care Physician (PCP), specialists, and medical providers to meet the complete medical and socio-economic needs of clients.
• Facilitate member access to community-based services and monitor referrals made to support the overall care management plan.
• Identify related risk management quality concerns and report 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.
• Coordinate service request/authorizations with UM and ensure agreement is aligned between the member, agency, and MCO.
• Facilitate member linkages to MCO-based services and programs in collaboration with agency staff.
• Assist members and/or agency staff with transportation to healthcare appointments.
• Participate in weekly rounds with agency staff.
• Act as the single point of contact for overall care management activities for the target population.
• Perform other duties as assigned.

Education/Experience

Graduate from an Accredited School of Nursing, with a Bachelor’s degree in Nursing preferred. You should have 2+ years of clinical nursing experience and 1+ years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care is essential, along with experience with medical decision support tools and government-sponsored managed care programs. Current state RN license is required.

Benefits

• Competitive pay within the range of $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.
• Health insurance coverage for you and your dependents.
• 401(k) and stock purchase plans.
• Tuition reimbursement and best-in-class training and development.