Care Manager – Behavioral Health

Category : Healthcare
Location/City : TX - Houston
Id : 41500

We are searching for a Care Manager – someone who works well in a fast-paced setting. This position will function as a member of the interdisciplinary healthcare team. This role will aid in the delivery of patient care with the underlying objectives of enhancing the quality of clinical and financial outcomes and patient satisfaction, while managing the plan of care. Within the purview of financial management, this role pro-actively communicates with members of the healthcare team and ensures appropriate medical necessity for patients in beds. This position will communicate with payers and the patient/family/healthcare team regarding payer information as necessary and will ensure that care is provided in a timely and efficient manner.
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Job Duties & Responsibilities
  • Gathers relevant data and obtains further information by interviewing patient/family and performing a careful evaluation of the entire situation
  • Plans and executes interdisciplinary and patient/family conferences as necessary to formulate and communicate the plan of care
  • Maintains a professional relationship with payer representatives and assists in resolving any utilization issues that arise
  • Assures timely performance of utilization management processes to maintain compliance with federal, state, and managed care contract regulations
  • Participates in the orientation and training of new department members Hou123

Skills & Requirements
  • Associate's degree in Nursing or a Diploma in Nursing required
  • Bachelor's degree in Nursing preferred
  • RN – Licensed Registered Nurses from the State of Texas Nursing Board
  • CCM – Certificate for Certified Case Manager from the Commission for Case Manager Certification required
  • FAACM – Fellowship in the American Academy of Case Management from The American Academy of Case Management/American Institute of Health Care Professionals required
  • ACM – Certificate for Certified Accredited Case Manager from the American Case Management Association required
  • CMCN – Certificate for Certified Managed Care Nurse from the American Board of Managed Care Nursing (ABMCN) or the American Association of Managed Care Nurses (AAMCN) required
  • CMCP – Certificate for Certified Managed Care Professional from the American Board of Managed Care Nursing (ABMCN) required
  • CPHQ – Certificate for Certified Professional Healthcare Quality from the National Association for Healthcare Quality (NAHQ) required
  • CPHM – Certificate for Certified Professional in Healthcare Management from McKesson
  • 3 years of experience as a Registered Nurse in an acute care or case management setting required
  • Pediatric and case/care management experience preferred

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