Remote RN Case Manager – Texas

Job Overview

  • Clinical License RN
  • State(s) TX

Full job description

REPORTS TO: Case Management Services Manager

LOCATION: Fully Remote, work at home

FSLA STATUS: Exempt

POSITION RESPONSIBILITIES:

The Case Manager (CM) will continue to manage and evaluates medical care alternatives for cases of illness, injuries or medical/surgical diagnoses that require extensive services. These cases may require acute rehabilitation, in-patient hospitalization, or preventive care in an attempt to avoid future complications or admissions. The role of the CM is to facilitate quality health care by decreasing fragmentation, enhancing patient’s quality of life, while containing costs, resulting in more effective outcomes. The CM will foster positive working relationships, both within Allegiance Care Management and with Allegiance Care Management’s external customers.

The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and be respectful and courteous in the conduct of this position.

ESSENTIAL JOB FUNCTIONS:

Essential job functions include the following. Other functions may be assigned as business conditions change.

1. The Case Manager will:

  • Assess, plan, implement, coordinate, monitor, and evaluate the treatment plan and/or develop alternative options, taking into consideration the medical and psychosocial needs of the patient throughout the continuum of care. The CM will identify and establish short and long-term goals in collaboration with the patient, the patient’s healthcare team, and the Plan.
  • Develop and implement a treatment plan taking into consideration the patient’s needs, resources available, and time frames for response to referrals, and to follow-up and evaluate the effectiveness and cost of the plan of care.
  • Act as patient advocate by speaking directly with the patient to discuss alternatives and identify treatment implications, and then maintain ongoing contact to monitor compliance and effectiveness of the treatment plan.
  • Coordinate services and assess progress and outcomes. Modify the plan and goals as the patient’s needs change by creatively and proactively identifying solutions using the resources available, maximizing benefits and services at all levels of care by meeting established criteria, performing utilization review with accurate and thorough documentation.
  • Provide education on the disease process, treatment options and costs. Reduced costs may be derived by utilization of participating providers, care networks, the negotiation of costs of services and/or supplies, and the limitation of unnecessary services.
  • The CM will refer to the Medical Director any case where there is a question of quality of care, questions on the disease process, and/or treatment plan in place.
  • Contribute to the daily workflow with regular and punctual attendance.

2. The Case Manager must communicate, verbally and in writing, clearly and effectively with team members, patients, patients’ families, health care providers, physicians and customers, both “internal and external.”

3. The essential job functions identified below will be evaluated through peer review, discussions with HealthCare Advisors, and random file review by the supervisor to ensure that all QA requirements are met.

4. The Case Manager must promote nursing professionalism:

  • Maintains current clinical knowledge and skills through the attendance of seminars, available Internet education, written works, or other similar resources on a biennial basis as evidenced by a documented 24 CEU hours during a two year renewal period as recognized by the State Board of Nursing.
  • Understands responsibility in preserving the patient’s confidentiality. This includes signing of an annual confidentiality statement and recognition that patient information is used only for purposes necessary for conducting case management.
  • Effective professional communication skills to all parties involved, (i.e.: listening, written, verbal).
  • Must be flexible to changing situations and needs.

5. The Case Manager organizes work load and contributes time and efforts to the team work load and responsibilities as evidenced:

  • Prompt return of phone calls within 24 hours or the next business day.
  • Daily review of all new referred cases and actions plans implemented.
  • Completing all case work and reporting in a timely manner in compliance with policies and procedures.
  • Attendance and/or participation in the majority of team meetings.
  • Identifying and/or providing feedback on department workflows to increase efficiency.
  • Participation in Policy and Procedures, CEU, and/or QA committees as assigned.

6. The Case Manager must be able to operate a personal computer, copier, fax machine, and telephone. Must be able to access, research, and extract information from printed resources, computer terminals, medical records, and telephone interviews on a daily basis. This will be evidenced by demonstration of skills during random observations.

NON-ESSENTIAL JOB FUNCTIONS:

1. Preparation of forms, faxing, copying.

2. Organization of files and reference materials.

3. Ability to operate typical office equipment and working knowledge of basic office principles.

PHYSICAL WORKING CONDITIONS:

Physical requirements are representative of those that must be met to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Sitting: 80%

Reaching: Minimal

Standing: 10%

Manual Dexterity: Ability to type/keyboard

Walking: 10%

Telephone: High Degree

Kneeling: As needed

Computer Screen: High Degree

Bending: As needed

Lifting: 25 pounds

JOB SPECIFICATIONS:

To perform this position successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Licensure:

  • Bachelors degree or higher in a health-related field and licensure as a health professional or RN Licensure and three (3) years clinical practice experience
  • Current licensure as an RN
  • Certified Case Manager certification required, may be obtained after hire date.
  • Must maintain all licensure credentials

Other Experience:

  • Must possess organizational skills and the ability to prioritize multiple tasks, attention to detail and follow through to completion.
  • Excellent oral and written communication skills required.
  • PC skills, including Windows and Word. Ability to learn all functions of the claims processing software as is necessary for claims processing and adjudication. Must be able to adapt to software changes as they occur.
  • Excellent listening skills.
  • High level of interpersonal skills to work effectively with others.
  • Ability to organize and recall large amounts of detailed information.
  • Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations and make appropriate applications to specific situations.
  • Thorough knowledge of claims processing procedures and requirements.
  • Ability to project a professional image and positive attitude in any work environment.
  • Ability to comply with privacy and confidentiality standards.
  • Ability to be flexible, work under pressure and meet deadlines.
  • Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions.
  • Ability to operate typical office equipment.
  • Working knowledge of general office procedures
  • Allegiance Benefit Plan Management, INC is an Equal Opportunity Employer. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: recruiting@askallegiance.com for support.

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