Nurse Case Management Manager is responsible for overseeing the functions of Service Coordination within the nursing facilities to ensure contractual requirements for Star Plus nursing facility members are met. The manager will be responsible for managing the day to day operation for their assigned service coordination team while providing assignment monitoring, evaluating quality of coordination, coaching, and team leadership for their service area.

Essential Duties and Responsibilities:

• Leads, directs, and monitors the delivery of all service coordination functions.
• Implements procedures and policies established by Client that enhance the quality of life for people receiving services.
• Provides leadership and collaboration with other managers and departments to assure compliance with local, state and federal regulations, nursing practice standards as well as standard operational structure across the Texas.
• Ensures effective and efficient budget management in providing the best utilization of resources.
• Provides effective staff management (hiring, development, training, performance feedback, etc.) that assures utilization of personnel to best meet the needs of the people receiving supports and services.
• Supports training that assures the best possible delivery of health related supports and services.
• Ensures the completion of accurate service coordination documentation to provide continuity of care and record storage.
• Oversees caseload assignments/priorities
• Monitors monthly productivity and goal status
• Assists with the implementation of workflows; Monitoring processes to ensure adequate acknowledgement, research and resolution to daily encounters for staff development
• Coordinates and completes staff check ins and audits to provide feedback to direct reports
• Attends applicable committees, as assigned
• Holds team meetings no less than monthly
• Conducts staff training in accordance with approved curriculum and approved presentations and maintaining a training log of training provided and attendance
• Conducts monthly staff meetings
• Keeps current on regulatory and company-wide changes impacting complex case management
• Attends required leadership meetings
• Travel 25% out of service area
• This role will start off working from home in Tyler,Texas and move to onsite TBD.
• Candidate must live in one of the following counties: Smith, Wood, Upshur or Rusk.

Required Qualifications:

• Must be a Registered Nurse with a current, unrestricted Texas License
• At least two years’ experience in management or administration
• Strong organizational and time management skills
• Must have strong computer skills using MS office products including Word, Excel, Power Point, and Outlook
• Excellent verbal, written, communication and presentation skills
• Strong knowledge of the Medicare/Medicaid Managed Care business
• Ability to meet deadlines and manage multiple priorities
• Effectively adapt and respond to complex, fast-paced, changing environment.
• Ability to make decisions on what needs to be done based on clearly established guidelines
• Experience managing process workflows.

Preferred Knowledge, Skills, Abilities:

• Bachelor’s degree preferred
• Previous STAR+PLUS experience.
• Home Health Case Management experience with Medicare or Medicaid populations a plus
• Experience managing members with chronic disease processes
• Experience working with community resource organizations
• Experience with care management software applications