Nurse Case Manager - PCHP (Dallas, TX, US) - Parkland Hospitals

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Primary Purpose

Responsible for daily case management and care coordination for health plan members. Ensures a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individuals and familys comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effective outcomes.

Minimum Specifications

Education: Must be a graduate of an accredited school of nursing. Bachelor's degree in nursing is preferred.

Experience:

• 3+ years of experience nursing in a clinical, medical or disease specific management setting.
• 3+ years of managed care case management experience is preferred.

Equivalent Education and/or Experience

- May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.

Certification/Registration/Licensure

- Must have and maintain current, valid RN license or temporary RN license from the Texas Board of Nursing; or, valid Compact RN license.

- Prefer Certified Case Manager (CCM) or American Nurses Credentialing Center (ANCC) RN-BC credential in case management.

Required Tests for Placement Skills or Special Abilities

- Proficient in medical and managed care terminology.

- Competent in application of case management standards.

- Familiar with auditing processes and regulatory/accreditation requirements (TDI, NCQA, URAC, CMS).

- Aptitude for interpreting reports and using Excel spreadsheet functions, such as formulas, graphs, and formatting.

- Ability to analyze and resolve complex and conflicting information.

- Proficient in meeting NCQA standards. - Knowledge of Federal and Texas Medicaid regulations. -

- Ability to develop and foster positive interpersonal relationships to effectively communicate and engage all levels of stakeholders.

Responsibilities

- Provides input into and follows the Case/Disease Management and Quality Management plans and assists with data collection for reports.

- Adheres to CMSA's Standards of Practice for Case/Disease Management and complies with health plan policies.

- Participates in self-audits and peer reviews to ensure compliance with regulations, standards, and departmental policies and provide feedback for the Case/Disease Management training program.

- Conducts Case/Disease Management activities according to model of care, program description and policies and procedures to provide timely, quality care and services to members.

- Gathers available clinical information for new and existing cases, performs case reviews based on policies and assessments, and refers to medical director as per policy.

- Completes case interventions according to time and completeness requirements and documents all actions and decisions.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.