RN Nurse Case Manager - McAllen, Texas -
|Position Title:||RN Nurse Case Manager - McAllen, Texas|
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Description of the Position: RN Nurse Case Manager - McAllen, TexasCompany: Cigna Careers
Description: Primary Duties and Responsibilities: 1. Works with member, member's family, and providers to develop and implement a comprehensive individualized service plan. 2. Conducts a comprehensive in person and/or telephonic member assessment using state mandated assessment tools. 3. Conducts health risk and other member assessments. 4. Uses clinical judgment to identify physical and behavioral health needs and works with the member and caregiver to establish an appropriate plan of care and services that minimize needs based on medical necessity criteria and benefit guidance. 5. Works with member to close clinical and pharmacy gaps and to mitigate non-clinical barriers to care. 6. Acts as a liaison and facilitates the coordination of benefits, resources, healthcare providers, and institutions. 7. Completes and files all assessments and implements the care plans within the timelines outlined by the state. 8. Maintains a maximum weekly face to face visit schedule of seven members for field-based nurse coordinators, average caseload of 125. Qualifications: Required Qualifications: · Must be a Registered Nurse with a current, unrestricted Texas License · Strong organizational and time management skills · Must have strong computer skills using MS office products including Word, Excel, and Outlook · Excellent verbal and written communication skills · Must have r eliable transportation, a valid and unrestricted driver's license and proof of insurance. · The ability to travel to members' homes, and other locations within the service delivery area. Preferred Qualifications: · Previous STAR+PLUS experience. · Home Health Case Management experience with Medicare or Medicaid populations a plus · Experience managing members with chronic disease processes and · Experience working with community resource organizations preferred · Experience with care management software applications preferred. US Candidates Only : Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us at .
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