Service Coord - RN Valley
On-site · McAllen, Texas, United States
Job Summary
The Service Coordinator RN will focus on person-centered care planning, assessing and coordinating Long-Term Services and Supports (LTSS) to maximize member health, wellbeing, and independence. Responsibilities include facilitating patient care through collaboration with healthcare providers, assessing clinical findings, and ensuring appropriate care levels. The ideal candidate should possess a BSN or ADNS, hold active licensing in Texas, and have significant experience in clinical and managed care settings. Preferred qualifications include CCM certification and prior management experience.
Required Qualifications
- Current, active, and unrestricted RN, NP, or PA licensure in the State of Texas
- Minimum of 3 years of clinical experience as a Registered Nurse
- One year of experience as a case manager or managed care case/utilization management experience preferred
- Minimum of three (3) years prior management experience in health services within a managed care organization preferred
- In-depth knowledge of the State of Texas’ managed care and managed Medicaid process preferred
- Previous experience with the State of Texas STAR+PLUS program or similar programs dealing with SSI and disabled children preferred
- Current Texas driver’s license and insurance maintained throughout the term of employment
Desired Qualifications
- Certified Case Manager (CCM) certification preferred
- Resource Utilization Group (RUG) and/or Patient Driven Payment Model (PDPM) certification preferred
- Knowledge of Medicare preferred
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