The role involves a collaborative practice to assess, plan, and coordinate health and human service needs for Driscoll Health Plan members
Job Summary
The role involves a collaborative practice to assess, plan, and coordinate health and human service needs for Driscoll Health Plan members.
Case managers must be knowledgeable in Medicaid criteria, managed care contracts, and data-driven decision-making tools to ensure cost-effective interventions.
The position requires managing members with chronic illnesses such as heart failure, diabetes, and bipolar disorder while ensuring safe discharge planning.
Matching Summary
The role involves a collaborative practice to assess, plan, and coordinate health and human service needs for Driscoll Health Plan members.
Skills & Requirements
Must-have
Current Texas RN licensure required
Knowledge of Medicaid criteria guidelines
Managed care contract knowledge
InterQual or similar criteria sets
Chronic disease management experience
Discharge planning and prior authorization
Nice-to-have
Acute inpatient case management experience
Disease management program expertise
Vendor negotiation skills
Performance improvement participation
Collaborative multidisciplinary teamwork
Key Requirements
Graduate of an accredited school of Nursing
Minimum three years prior clinical experience
One year acute inpatient or managed care experience preferred
Active unrestricted Registered Nursing license in Texas
Case Management certification preferred within two years