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Manager RN, STAR+PLUS Health Care Management - El Paso, TX Job
Amerigroup
Date: Jun 11, 2013
Location: El Paso, TX, US
Manager RN, STAR+PLUS Health Care Management - El Paso, TX
Job ID 2012-19498 # Positions 1
Location US-TX-El Paso
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 6/10/2013
Additional Locations ..
More information about this job:
Summary:
The manager is responsible for providing clinical supervision to a team responsible for utilization, access, and concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services.
This position is located at the on-site office of Amerigroup Community Care of El Paso, Inc.
Responsibilities:
PRIMARY RESPONSIBILITIES:
1. Manages and oversees team responsible in case finding and coordinating those cases that involve comorbid conditions and need to be part of the case management/disease management track.
2. Manages and evaluates team's performance and ensure adherence to department's standards.
3. Responsible for coordination and service delivery to include member assessment of physical and psychological factors.
4. Works with providers to establish short and long term goals that meet the member's need, functional abilities and referral sources requirements.
5. Communicates care plan objectives utilizing community resources to individuals, departments, and providers identified as having a role in the care of members.
6. Coordinates the identifications of members with potential for high risk complications.
7. Assesses members' present level of physical/mental impairment utilizing defined criteria and methodology.
8. Demonstrates understanding of the physical and psychological characteristics of illness, disabilities and wellness and makes referrals when appropriate.
9. Review benefit systems and cost benefit analysis.
10 Evaluates the member against level of care criteria.
11 Demonstrates knowledge of utilization management targets.
12 Acquires data and evaluates necessary medical, mental health and substance abuse service for cost containment.
13 Requests direction from Medical Director on complex healthcare issues.
14 Maintains member confidentiality and respect of the patient bill of rights.
15 Other duties as assigned.
Qualifications:
EDUCATION AND EXPERIENCE:
Education
Required: Bachelors Degree, or equivalent work experience
Years and Type of Experience Required:
Required: Five years experience in Health Care Management and at least one year of leadership/management experience.
Knowledge and Technical Skills
Required:
Advanced Computer skills to include Microsoft Word and Excel; Microsoft Products
Ability to provide supervision to telecommuting multidisciplinary team
Strong decision making skills ' Ability to provide services in an environment that involves multiple health, mental health and substance abuse care systems.
Ability to interact with all relevant components of the health and behavioral health care systems
Self starter with the ability to handle multiple projects at one time.
Strongly Preferred: Bilingual - Fluent in both English and Spanish.
Certifications or Licensure
Required: RN - licensed in the State of Texas. Must be RUGs Certified. Requires valid driver's license and valid auto insurance with coverages at least state minimum.
SCOPE INFORMATION Item Measure
# Direct Reports 2-10 (or individual contributor in a coaching/training capacity within the department)
Budgetary $ Responsibility none
PHYSICAL REQUIREMENTS
Able to operate a computer
Must have valid driver's license
Ability to travel on commercial airliner when needed
ermHO
Job ID 2012-19498 # Positions 1
Location US-TX-El Paso
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 6/10/2013
Additional Locations ..
More information about this job:
Summary:
The manager is responsible for providing clinical supervision to a team responsible for utilization, access, and concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services.
This position is located at the on-site office of Amerigroup Community Care of El Paso, Inc.
Responsibilities:
PRIMARY RESPONSIBILITIES:
1. Manages and oversees team responsible in case finding and coordinating those cases that involve comorbid conditions and need to be part of the case management/disease management track.
2. Manages and evaluates team's performance and ensure adherence to department's standards.
3. Responsible for coordination and service delivery to include member assessment of physical and psychological factors.
4. Works with providers to establish short and long term goals that meet the member's need, functional abilities and referral sources requirements.
5. Communicates care plan objectives utilizing community resources to individuals, departments, and providers identified as having a role in the care of members.
6. Coordinates the identifications of members with potential for high risk complications.
7. Assesses members' present level of physical/mental impairment utilizing defined criteria and methodology.
8. Demonstrates understanding of the physical and psychological characteristics of illness, disabilities and wellness and makes referrals when appropriate.
9. Review benefit systems and cost benefit analysis.
10 Evaluates the member against level of care criteria.
11 Demonstrates knowledge of utilization management targets.
12 Acquires data and evaluates necessary medical, mental health and substance abuse service for cost containment.
13 Requests direction from Medical Director on complex healthcare issues.
14 Maintains member confidentiality and respect of the patient bill of rights.
15 Other duties as assigned.
Qualifications:
EDUCATION AND EXPERIENCE:
Education
Required: Bachelors Degree, or equivalent work experience
Years and Type of Experience Required:
Required: Five years experience in Health Care Management and at least one year of leadership/management experience.
Knowledge and Technical Skills
Required:
Advanced Computer skills to include Microsoft Word and Excel; Microsoft Products
Ability to provide supervision to telecommuting multidisciplinary team
Strong decision making skills ' Ability to provide services in an environment that involves multiple health, mental health and substance abuse care systems.
Ability to interact with all relevant components of the health and behavioral health care systems
Self starter with the ability to handle multiple projects at one time.
Strongly Preferred: Bilingual - Fluent in both English and Spanish.
Certifications or Licensure
Required: RN - licensed in the State of Texas. Must be RUGs Certified. Requires valid driver's license and valid auto insurance with coverages at least state minimum.
SCOPE INFORMATION Item Measure
# Direct Reports 2-10 (or individual contributor in a coaching/training capacity within the department)
Budgetary $ Responsibility none
PHYSICAL REQUIREMENTS
Able to operate a computer
Must have valid driver's license
Ability to travel on commercial airliner when needed
ermHO
Nearest Major Market: El Paso
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