POSITION SUMMARY/RESPONSIBILITIES
Analyzes, coordinates, and documents care coordination services for patients based on established criteria, plan policies and procedures.
EDUCATION/EXPERIENCE
- Graduation from an accredited school of nursing, RN or LVN is required.
- A minimum three years of clinical nursing experience is required.
- Data entry, referral management, utilization management experience is required.
- Case management and call center experience preferred.
- Knowledge of e-mail, QM principles, and utilization management tools preferred.
- Claim review/audit experience a plus.
LICENSURE/CERTIFICATION
- Current licensure in the State of Texas as an RN or LVN is required.