Under the general direction of the Manager of Case Management, this nurse case manager identifies, screens, tracks, monitors, and coordinators the care of members with multiple co-morbidities and/or psychosocial needs. The position has frequent or daily needs access to confidential information and protected health information. Other duties as assigned.

Essential Duties (at least 5 that are non-negotiable duties and are absolutely pertinent to successfully completing the job without accommodations):

• Complete a comprehensive physical, medical, and psychological assessment on high risk high cost patients via telephonic interview.
• Establish care plan, goals, interventions, and contact schedule based on risk category, and patients/family members identified medical and social needs
• Promote compliance with disease specific clinical outcomes by providing each individual with self-management supports including disease specific education materials, nutritional recommendations, exercise/activity, signs/symptoms to watch for and report to your MD, and Care plan and treatment goals including self-management goals
• Coordinate care and communication between multiple providers, medical, nursing, social, and behavioral health
• Must be able to independently travel off-site to various locations.

Knowledge/Skills/Abilities:

• Clinical knowledge in the treatment of injuries, diseases and deformities including symptoms, treatment alternatives, drug properties and interactions and preventive health guidelines.
• Working knowledge of Case Management principles and processes
• Experience in Medicaid Managed Care including STAR and CHIP.
• Experience with Commercial, Health Care Exchange Programs and other county programs.
• Ability to manage workload efficiently and effectively and within established policies and procedures.
• Excellent interpersonal skills with the ability to interface and interact effectively with members, providers, health plan staff and other external customers.
• Strong verbal, listening and written communication skills including detail oriented and concise documentation skills.
• Knowledge of HHSC, TDI, NCQA and HEDIS regulations, standards, or measures to assure overall compliance with all standards.
• Working knowledge in the use of a personal computer and of Microsoft Office products including Word, Excel, Outlook, and Power Point.

MINIMUM EDUCATION:   Completion of an accredited Registered Nursing Program

MINIMUM EXPERIENCE:   

• 3 years of experience in community health setting, public health, chronic disease management, community nursing, case management
• Experience in care coordination and disease management/education
• Experience working with primary care providers in practice setting to coordinate care and disease management
• Strong communication skills, both verbal and written
• Knowledge of case management, disease management, and chronic care principles

REQUIRED CERTIFICATIONS/LICENSURE:   
Active and unrestricted state Registered Nursing License in good standing