Job Description
Built to Care. Driven to Improve. At Community Health Choice, we're a nonprofit health plan dedicated to improving the health and well-being of Texans, especially underserved communities. Our employees bring purpose into practice every day through compassion, collaboration, and a commitment to better outcomes. In this remote role, you'll be responsible for conducting telephonic or face-to-face clinical assessments to identify, evaluate, coordinate, and manage members' needs across physical health, behavioral health, social services, and long-term services and supports.
Duties include:
Identify members at high risk for complications and coordinate care with members and the health care team. Manages members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost-effective and efficient utilization of health benefits. Obtains a thorough and accurate member history to develop an individual care plan. Establishes short- and long-term goals in collaboration with the members, caregivers, family, natural support, and physicians; identifies members who would benefit from an alternative level of care or other waiver programs. The RN has overall responsibility for developing the care plan for services for the members and ensuring the members' access to those services. May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within the benefits structure or through extra-contractual arrangements, as permissible. Interfaces with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on the development of care management treatment plans. May also assist in problem-solving with providers, claims, or service issues. Directs and/or supervises the work of any LPN/LVN, LSW, LCSW, LMSW, and other licensed professionals other than an RN, in coordinating services for the member by, for example, assigning appropriate tasks to the non-RN clinicians, verifying and interpreting member information obtained by these individuals, conducting additional assessments, as necessary, to develop, monitor, evaluate, and revise the member's care plan to meet the member's needs, and reviewing and providing input on the non-RN clinicians' performance on a regular basis. Assists in meeting members' needs by referring members to internal and external resources. Provide follow-up with internal and external resources, providers, and state programs. Coordinate with and participate in ICT meetings with Nursing Facility Staff, members, Responsible Party, treating physicians, therapists, and any other applicable parties. Coordinate and assist with the transition to the community through the Money Follows the Person (MFP) process for any member who indicates a desire to leave the nursing facility. Community employees' benefits are provided by Harris Health. These benefits are designed to provide you with flexibility and options to meet your specific needs. Community is an Equal Opportunity Employer. Harris Health's benefits program is designed to provide you with greater flexibility and more choices to meet your specific needs. Harris Health's benefits program allows you to protect your income in case of illness, death, and disability, and to help you save for retirement. Current unrestricted RN license in Texas, Graduate of an accredited school of nursing; bachelor's degree in nursing preferred. CCM 3-4 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background. 1 year experience working with the population who receive waiver services, 1 year experience working with people with disabilities/chronic conditions, and Long-Term Services & Supports. Microsoft Office, clinical documentation platforms, and the internet Local travel Reliable transportation with a valid driver's license and a good driving record
