RN Case Manager

Job not on LinkedIn

🔥 3 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

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👻 Ghost score 15%

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GuideWell Source

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

GuideWell Source is a company within the GuideWell Family that focuses on accelerating innovative health solutions to market, transforming and reshaping the health industry. It specializes in healthcare delivery, providing new models and superior outcomes for patients. The company emphasizes consumerism in healthcare, engaging clients in meaningful ways. GuideWell Source offers healthcare insurance, protecting employers and consumers with coverage plans and services. The company also provides administrative and claims processing services for state and federal Medicare and Medicaid programs, establishing itself as a trusted business partner in the healthcare sector with a focus on operational excellence.

📋 Description

• Create, implement, and monitor treatment plans to help patients/members meet healthcare goals • Assess members’ health status and care coordination needs • Perform inpatient review, discharge planning, and possible outpatient management • Contact patients, families, physicians, healthcare providers, community resources, provider business offices, and employers/clients • Identify and coordinate alternative treatment plans within quality-care and cost-containment guidelines • Assess clinical status and sequelae to coordinate appropriate services • Monitor health status and treatment-plan impact, adjusting care plans as client needs change • Identify services, resources, providers, and facilities that best serve members in a timely and cost-effective manner • Develop and implement short- and long-term case management goals with documented care plans • Evaluate treatment-plan cost effectiveness before and after implementation • Produce accurate and timely reporting • Review medical records to determine medical necessity • Interpret individual health plans and authorize or coordinate care according to plan provisions

🎯 Requirements

• Ability to work Monday to Friday, 9a-6p CST or 10a-7p CST • California RN state license • 5+ years related work experience with a professional background in clinical nursing and patient assessment • Related Bachelor’s degree or additional related equivalent work experience • Graduate of an accredited school of nursing • RN - Registered Nurse - State Licensure • Knowledge of medical terminology, reasonable and necessary treatment plans, delivery quality health care services and cost containment practices • Ability to collaborate with cross-operational areas within the organization • (CCM) Certified Case Manager preferred • Compact State Licensure in good standing preferred • Prior experience in utilization management or case management, preferably within the managed care environment, preferred • Intensive care or higher-acuity patient experience preferred • Knowledge of managed care in a self-funded employer population preferred • Ability to identify problems such as underutilization or overutilization of services • Ability to promote and maintain quality care through analysis

🏖️ Benefits

• Medical, dental, vision, life and global travel health insurance • Income protection benefits: life insurance, Short- and long-term disability programs • Leave programs to support personal circumstances • Retirement Savings Plan includes employer contribution and employer match • Paid time off, volunteer time off, and 11 holidays • Additional voluntary benefits available • Comprehensive wellness program