Disease Management RN - Health Plan Job

Children's Health - HMO Careers

Job Number: 51448

Location: Dallas, TX

Date Posted: 2-23-2017

Description:

Position Summary

Responsible for the State's requirements to identify medical and behavioral conditions. Provide clinical supportive materials, interventions and reporting elements to assess the effectiveness of each disease management program. Assist in the coordination and discharge process, collaborate with Medical homes and monitor the outcomes for our members throughout the care continuum.

Essential Duties and Responsibilities

  • Perform treatment plan contacts
  • Assess treatment plans to identify barriers and find alternatives
  • Develop member care plans and provide disease management recommendations
  • Serve as an advocate to interpret and educate the member on their disease/condition as well as explain the interdisciplinary team approach and recommendations
  • Modify the care plan based on behavioral/physical limitations and various assessments

Qualifications

Education

  • Two-year Associate's degree or equivalent experience, required

Licenses & certifications

  • Active, unrestricted Texas State Registered Nurse (RN) license in good standing, required
  • Certified Case Management (CCM), preferred
  • Utilization Management Certification, preferred
  • Professional in Health Care Quality (CPHQ), preferred

Experience

  • 3+ years RN clinical nursing experience, required
  • 2+ years disease management experience, required

Specific knowledge, skills and abilities

  • Requires experience in own professional discipline to appropriately apply own knowledge; broadens own professional expertise and acquires higher level skills
  • Understands key business drivers; uses this understanding to accomplish own work
  • No supervisory responsibilities but may provide informal guidance to new team members
  • Solves problems in straightforward situations; analyzes possible solutions using professional/technical experience, judgment and precedents
  • Impacts quality of own work and the work of others on the team; works within guidelines and policies
  • Receives a moderate level of guidance and direction
  • Explains complex information to others in straightforward situations

Physical demands

  • Duties require little or no exertion of physical effort.

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