Certified Case Manager (CCM), Clinical Assessment, Documentation, Functional Analysis, Home Care, Maintain Compliance, Managed Care, Member Orientation, Nursing, Nursing Credentials, Organizational Skills, Registered Nurse (RN), Risk Management, Saba Platform, Time Management, Urgent Care
Summary:
Duration: 12 months, possible to extend
Location: Will be responsible for delivering member-facing nursing services and care coordination in the following counties: Bell, Bosque, Burleson, Comanche, Erath, Gillespie, Grimes, Lampasas, Llano, McLennan, Mills, San Saba, Washington Counties
Shift: Mon - Fri 8am - 5PM CST
Responsibilities:
- Conduct direct member care coordination, field visits, and compliance-driven assessments within the STAR PLUS LTSS Waiver program
- Perform in-home or community-based visits for annual reassessments, bi-annual reassessments, and change in condition visits
- Complete comprehensive clinical and functional assessments
- Develop person-centered service plans
- Coordinate with PCPs, specialists, and agencies
- Address care gaps and urgent needs
- Facilitate service authorizations and referrals
- Provide member and caregiver education
- Complete real-time, audit-compliant documentation
- Manage escalations and complaints
- Ensure timely closures of worklist items and follow-ups
- Develop and update service plans appropriately
- Identify and close care gaps
- Reduce safety risks or service delays
- Effectively coordinate services
Requirements:
- Graduate from an Accredited School of Nursing
- RN Texas State License
- Minimum 4 years of related experience
Preferred Skills:
- Bachelor’s degree in Nursing
- Experience with other MCOs, home health nursing, or case management
- Accountable for completing tasks completely and accurately due to remote position
- Organized and time-efficient to meet turnaround times and documentation compliance
- Critical thinker that is detail-oriented to assess high-acuity members