Disease Management RN - Health Plan Job

Children's Health - HMO Careers

Job Number: 52106

Location: Dallas, TX

Date Posted: 6-28-2017

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.

JOB PROFILE

  • 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

JOB SPECIFIC RESPONSIBILITIES

  • Coordinate member's individual treatment program using clinical guidelines with attention to quality of care and cost containment
  • Perform treatment plan contacts
  • Assess treatment plans to identify barriers and find alternatives
  • 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

  • Associates Degree in Nursing required. Bachelor of Science Degree in Nursing highly preferred.

Experience

  • Three plus years Clinical Nursing experience required
  • Two plus years Disease Management experience required.

Licenses and Certifications

  • Active, unrestricted Texas State Nursing license in good standing required
  • Valid Texas Drivers License required
  • Certified Case Management (CCM) preferred
  • Utilization Management Certification preferred
  • Professional in Health Care Quality (CPHQ) preferred

PHYSICAL DEMANDS

Light - Exerting up to 20 lbs. occasionally, 10 lbs. frequently, or negligible amounts constantly and may require walking or standing to a significant degree.


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