RN Case Manager

Altus Accountable Care Entity (ACE) is a physician-led organization empowering doctors to deliver high-quality, value-based care within their communities. Altus ACE works in partnership with Managed Care Organizations to provide care coordination services directly to patients in the STAR+PLUS, STAR+PLUS MMP (dual eligibles) and Medicare Advantage programs. Our unique community-based care model achieves quality results and healthcare savings that are shared with our physician partners.

Job Title: RN - Case Manager

Status: Exempt

Reports To: Nurse Manager

Salary: Up to $80,000 DOE

Location: Houston, TX

Telecommute Position: The chosen candidate must be able to travel throughout the Houston area to meet with Members. When not out in the field the chosen candidate is expected to work from home.

Summary: We are looking for Registered Nurses who have the specific knowledge and skills required for care management and provide case management across the health care continuum. They utilize clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options and services to facilitate appropriate health care outcomes for Members. The Registered Nurses assists Members at self-management support and navigation thru the health care system. He/she always works to achieve the best possible clinical outcomes for the Member

Essential Duties and Responsibilities:
Identification and risk stratification of Members; applies data driven methods of identification of Members, following appropriate procedures for identifying, screening and assessing Member needs.

Proactive and predictive identification and appropriate recommendations for referrals to alternative health care programs ( e.g. , disease management, case management).

Conducts comprehensive health risk assessments (HRA) of Member’s clinical and psycho-social care needs and determines approaches to meeting needs either through the Altus ACE, the Member’s benefits plan or external programs and services. Assessments may be in person or telephonic.

Assists with teaching and coordinating medical and social referrals across the continuum of care including assistance with Medicaid recertification.

Develop and implement mutually agreed upon, person-centered care plans that include long-term and short term goals aimed at improving the Member’s overall health.

Evaluates and identifies health care service delivery using clinical knowledge to sequence services such that the Member receives care in the setting that best promotes quality and efficiency.

Reviews and approves all Member HRAs

Working with Medicaid and/or Medicare members who may be experiencing chronic and or complex biopsychosocial needs.

Qualifications/Requirements:

Active RN license with the State of Texas

Strong customer service skills to coordinate service delivery including attention to Members, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for Members.

Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Familiarity with basic medical terminology and concepts used in care management

Effective communication, telephonic and organization skills.

Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.

Reliable transportation to travel to member homes or other locations within service delivery area

Education and Certification Preferred:

Case Management certification preferred

Bilingual in Spanish preferred

3-5 years acute clinical/surgical experience

Previous case management experience, Managed care organization experience with Medicaid/Medicare and Duals or post-acute and/or Community care experience a plus.

Physical Demands: The employee must occasionally lift and/or move up to 25 pounds

All your information will be kept confidential according to EEO guidelines.

Reasonable Accommodations: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position.