Southwestern Health Resources is seeking to hire a Care Manager Registered Nurse to support our Care Coordination department.

The location is Southwest Health Resources- Southwestern Health Resources 1603 LBJ Freeway Farmers Branch TX 75234

Salary range is $36.09/hour - Max $51.04/hour - based on relevant experience.

Work Schedule

• Full Time: 40 hours per week, Monday-Friday 8:00am-5:00pm. This position will work from home with one day working in office each week.

The Care Manager - Registered Nurse will be responsible for the overall coordination of care, education, and management of care for members enrolled in the complex case management and disease management programs. The position will support the CM Department by managing the care needs of identified plan members with specific diseases. Responsibilities include: patient assessment/education via telephone, coordination of care, and transition planning across the continuum of care. The position works in collaborative practice with the physician and other members of the health care team to meet member needs. The position will ensure tasks and projects are consistent with company strategy, commitments, goals and timelines. The incumbent will possess the ability to effectively communicate with internal and external clients, and maintain a positive attitude while working in a dynamic, fast paced environment. The essential job duties of this position are:

• Responsible for meeting production goals on an ongoing basis as defined by leadership in order to meet business needs.

• Supports the Collaborative Care Management Model: Collaborating with physicians, social workers, pharmacists, and other professional staff in order to improve overall patient outcomes.

• Demonstrates effective caseload assignment through complex case management

• Demonstrates an understanding of funding resources, services, and clinical standards and outcomes.

• Demonstrates knowledge of case management standards of practice and processes including identification, assessment, planning, interventions, and evaluation.

• Accountable for on-going compliance with the policies and procedures. This includes the standards of accrediting bodies and the regulations of state and local governing agencies (i.e. CMS and Nursing Practice Act)

• Use interpersonal/communication skills and strategies with individuals to achieve: (a) desirable/acceptable outcomes/responses (b) perceptions of satisfaction or acceptance of those involved.

• Establish and/or revise priorities based on: (a) urgency of the patient or organization's need (b) resource availability (c) predetermined schedules (d) other department's/personnel's expectations.

• Demonstrates knowledge of NCQA and HEDIS Standards.

• Additional duties as assigned to meet business needs.

• Establish and maintain effective relationships with customers and gain their trust and respect.

• Provide clinical oversight for LVNs or SWs as needed within RN Nursing Guidelines (may include but not limited to medication reconciliation).

The ideal candidate will possess the following qualifications:

• Bachelor's degree nursing required.
• 3 years of experience Managed care and/or Clinical care experience required

• Case Management experience, And

• Disease Management experience required.

• Utilization Management and Pre-authorization experience preferred.

• Health plan experience a plus.
• RN - Registered Nurse upon hire required.
• CCM - Certified Case Manager Or, equal approved certification or must obtain within 18 months of employment or transfer into position required.

Skills
• Strong analytical and organizational skills.

• Working knowledge and ability to apply professional standards of practice in work environment.

• Knowledge of specific regulatory, managed care requirements preferred.

Southwestern Health Resources Clinically Integrated Network (SWHR CIN) is an affiliated company of Texas Health and UT Southwestern. If hired for this position, you will become a SWHR CIN employee rather than a Texas Health or UT Southwestern employee.