RN

Registered nurse, BSN- hybrid

Location- 120 E Harris Ave, San Angelo, TX 76903

Pay range $38- $43

Registered nurse, BSN

Texas Licensure

Resource Utilization Group (RUG) certification required

Must haves:

2 years of clinical nursing experience in a clinical, acute care, or community setting and 1 years of case management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs

Nice to haves:

2 years of clinical nursing or case management experience in a clinical, acute care, managed care or community setting. 2 years’ experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment. Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs

Field position, hybrid with field visits to member’s home. Visits can be up to 2 visits per day, 3 days a week.

Evaluates the service needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome

Develops and continuously assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed to address member's needs

Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services

Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / needs

Monitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicable

Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations

Reviews referrals information and intake assessments to develop appropriate care plans / service plans

Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed

Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines

Provides and/or facilitates education to long-term care members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits

Acts as liaison and member advocate between the member/family, physician, and facilities/agencies

Educates on and coordinates community resources. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living)

May perform home and/or other site visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required

Partners with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner

May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness

May provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice

May engage and assist New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success

Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
Performs other duties as assigned

Complies with all policies and standards

Job Types: Full-time, Contract

Pay: $38.00 - $43.00 per hour

Medical Specialty:

• Home Health

Physical Setting:

• Outpatient

Ability to Commute:

• San Angelo, TX 76903 (Required)

Ability to Relocate:

• San Angelo, TX 76903: Relocate before starting work (Preferred)

Work Location: Hybrid remote in San Angelo, TX 76903

Salary : $38 - $43