Nurse Case Manager - CFHP

Nurse Case Manager - CFHP at University Health summary:
The Nurse Case Manager at Community First Health Plan coordinates comprehensive care for members to optimize health outcomes and resource allocation. This role involves managing benefit utilization, collaborating with healthcare professionals, and ensuring access to necessary health services. A Registered Nurse with experience in acute care, managed care, and knowledge of healthcare coding and Medicaid/Medicare programs is required.
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 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 multidisciplinary 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 Inter Qual 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.
Keywords:
nurse case manager, registered nurse, care coordination, managed care, Medicaid, Medicare, health care services, benefit utilization, acute care nursing, community resources