Care Manager I - LVN (Houston, TX)

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence 
• Be Innovative
• Work As One Team

What You'll Do

• Identifies, arranges for, and monitors appropriate community services based on a working knowledge of Medicare, Medicaid, and other entitlement programs
• Coordinate and facilitate patient care through assessment, evaluation, planning, and implementation
• Communicate patient needs to a variety of care team members and follow up accordingly
• Manage discharge plans upon completion of treatment
• Work collaboratively with patients, families, physicians, nurses, and the multidisciplinary team to ensure high quality care
• Act as the patient's advocate as it relates to insurance coverage and financial assistance
• Maintain the patient's comprehensive clinical record through detailed documentation
• Coordinate an interdisciplinary approach to support timely access to appropriate care, facilitate continuity of care among providers and improve utilization of appropriate resources
• Apply established principles of care transition and follow patient through continuum of care as well as coordinate a warm hand-off to the appropriate provider and/or health plan for necessary involvement of continuation of care and services
• Assists Care Management Manager and participates in all internal and external audits
• Primary liaison with all contracted health plans for case management activities
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in Medical Group/ MSO policies and procedures related to HIPAA compliance
• Participate in special projects and perform other duties as assigned. 

Qualifications

• Active LVN license in the State of Texas required.
• At least three (3) years of clinical nursing experience, preferably in case management, care coordination, population health, utilization management, or a related healthcare setting required.
• At least three (3) years of hospital, acute care, or inpatient experience strongly preferred. 
• At least two (2) years of utilization management experience, including application of evidence-based clinical criteria and health plan benefits.
• Knowledge of Medicare, Medicaid, managed care, and community-based resources.
• Strong assessment, care coordination, documentation, and communication skills.
• Proficiency with electronic health records (EHRs) and care management systems.
• Certified Case Manager (CCM) certification preferred.
• Experience working within value-based care, managed care, ACO, IPA, MSO, or population health environments preferred.

Environmental Job Requirements and Working Conditions

• This is a full-time remote role requiring a minimum of one monthly in person team meetings at the Houston office, located at 9500 HWY 249, Suite 570 Houston, TX 77070. 
• The total compensation target pay range for this role is $60,000 - 74,000 annually. The salary range represents our national target range for this role.