Nurse Case Manager - CFHP
POSITION SUMMARY/RESPONSIBILITIES
Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by ensuring that members have access to all of the health care services they need in the most efficient and effective manner possible. Responsibilities include but are not limited to overseeing the allocation of resources, cost and quality of health care for members; coordinating care between the primary care physician, community resources, family and member; coordinating care across the health care continuum while monitoring and managing benefit utilization; and, collaborating with multi-disciplinary health care team members in identifying the educational and discharge needs of members.
EDUCATION/EXPERIENCE
Registered Nurse (RN) is required. Bachelor of Science in Nursing (BSN) or Master’s degree is preferred. Minimum three (3) years nursing, acute care, quality management or managed care experience is required. Basic knowledge of Medicaid, Medicare, community resources and alternate funding programs is desired. Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred.
LICENSURE/CERTIFICATION
Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. Current certification from an appropriate professional agency, such as Case Management Society, is preferred.
12238 Silicon Drive, San Antonio, TX, United StatesRecommended Jobs
Project Portfolio Manager
At Vestas we are powered by the dream of changing the world. And to create a sustainable future, we are building a team of motivated visionaries. Would you like to join us? Vestas is a major wind tu…
Principal Software Engineer
Recognized as the No. 1 site trusted by real estate professionals, Realtor.com® has been at the forefront of online real estate for over 25 years, connecting buyers, sellers, and renters with trusted…
Sr. Content Marketing Manager
About Measured Measured is the pioneer and leader of incrementality-based media measurement and optimization. Since 2017, leading brands have used our AI-powered, all-in-one platform to manage, …
Account Executive
Aerones is on the lookout for a dynamic Key Account Manager to join our team! In this pivotal role, you will be responsible for managing and nurturing relationships with our most valuable clients, …
Staff machine learning engineer
This job is with eBay, an inclusive employer and a member of myGwork – the largest global platform for the LGBTQ+ business community. Please do not contact the recruiter directly. At eBay, we're m…
General Field Professional - Logging & Perforating
We are looking for the right people - people who want to innovate, achieve, grow and lead. We attract and retain the best talent by investing in our employees and empowering them to develop themselves…
Contract Packaging Senior Sales Manager
Quality Packaging (Qual Pac) is looking for individuals who have a strong professional ethic, are passionate about innovating for positive change, and are collaborative team players. We have been in …
Engineering Talent Acquisition Partner
Find the minds that design the future. Own engineering hiring at Hilti. The Talent Acquisition Partner is responsible for attracting, assessing, and hiring diverse talent to Hilti North America (H…
US Expat Tax Accountant (Remote)
Our client is an award-winning remote US tax firm focused exclusively on Americans living abroad. They are hiring a US Expat Tax Accountant (100% remote) to take ownership of technically complex …
Travel Nurse - Med Surg Job in Fort Worth, TX - $6,684 per Month (2 Years Experience Needed)
Vetted is seeking a RN - Med Surg for a travel job in Fort Worth, Texas . Must have 2+ years of experience. This contract pays approximately $6,684/month gross. Assignment details: Con…