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Nurse Case Management Lead Analyst (TX)
Ref No.: 20-04219
Location: Mcallen, Texas
Pay Rate : $ 26.84 - 46.43 /Hour
TITLE: RN Triage Case Manager
SCHEDULE: Monday-Friday 8:00a-5:00p

*The position is work from office however, due to COVID-19, the office is closed and employees will have to work at home until we are allowed to return to the office.*

Under general supervision of the Director of Clinical Programs and the Manager of Complex Case Management, the RN Triage CM is responsible for assessing members with multiple and complex medical conditions who need post discharge care transition for thirty days post discharge. The RN Triage CM will complete weekly calls to the member focused on Managing the transition from acute hospital to home for the first thirty days.

  • Bilingual: Spanish & English
  • Two or more years of clinical experience with discharge planning or case management in a managed care or hospital setting with the Medicaid and or Medicare population
  • Two or more years of clinical experience and knowledge of chronic conditions (Diabetes, CHF, CAD and hypertension, COPD and Asthma, Renal Disease and mental health conditions including depression, bipolar disease)
  • Proficiency in Microsoft Office Word, Excel and windows based systems.
  • Experience using medical management systems to review claims, medications, and test results and document assessments and clinical notes.
  • Excellent written and verbal skills in communicating with Members, Caregivers and providers
  • Prior experience and knowledge of making referrals to community resource organizations
  • Good problem solving skills and the ability to triage based on severity
  • Excellent interpersonal skills and the ability to work in a team environment
  • Associate's Degree minimum
  • Current licensure as a Registered Nurse (RN) in Texas or active license in a state allowing "multistate privilege to practice”
  • Certified Case Manager preferred but not required and prefer previous experience with Case Management or Manage Care Organization Experience.
  • Case Management
  • Billingual: English & Spanish
  • MS Office Suite
  • Medical Management
  • Medicare
  • Discharge Planning
  • Mental Health