Case Manager

Responsible for coordinating the delivery of cost-effective, quality-based healthcare services for health plan members by development and implementation of alternative treatment plans that address individual needs of the member, their benefit plan and community resources.

 Responsibilities and Functions

 Identify high-risk/high-cost patients for possible case management intervention. Interface with providers of medical services and equipment to facilitate effective communication, referrals, development of discharge planning and alternative treatment plan development. Work closely with the inpatient team to identify discharge planning and alternative treatment plan development. Initiate contact with patient/family, physician and health care providers/suppliers to discuss the alternative treatment plan. Conduct on-site evaluations as necessary. Collaborate with the attending physician to achieve identified patient outcomes. Coordinate the treatment plan to accommodate the health service needs of the patient, benefit availability and community resources. Monitor and evaluate (at least every 30 days) that the plan remains appropriate. Extend, revise or close treatment plans as appropriate. Refer questionable case management cases or requests to the Medical Director. Communicate denial decisions to all appropriate parties following established guidelines. Evaluate each case for quality of care, documents quality issues and appropriately refer case with questionable quality of care to the Manager of Quality Assurance. Produce monthly reports that update the patient?s progress and submit the reports in a timely fashion to the appropriate party (patient, family, physician, payer). Communicate with all departments to resolve issues or document trends. Understand and follow administrative guidelines (policy and procedure) of the unit. Attend and actively participate in weekly staff meetings.

 Minimum Requirements

 

Education: Current Licensure as a Registered Nurse in the state of Texas

Prefer certified case manager.

 

Experience:  Five (5) years recent experience in an acute care environment, or

2 years recent experience in a case management or utilization management position

 

Job Related Skills:Verbal and written communication skills. Interpersonal skills. Basic mathematical and statistical ability Organizational skills Knowledge of utilization review requirements and procedures. Knowledge of current heath care practices and appropriate treatments.

 

HealthSpring offers a competitive salary and a full range of benefits.

 

Go to www.texashealthspring.com & complete an online application.

 

Select Department:  Health Services

Select Position: Case Manager

 

Attach resume. Include salary history/requirement. No phone calls accepted.

HealthSpring, Inc. is an EEO/AA employer.