Senior Care Manager (Irving, Texas)

Health Net, Inc (NYSE: HNT) is among the nation’s largest publicly traded managed health care companies.  Health Net’s mission is to help people be healthy, secure and comfortable.  The company’s POS, HMO, insured PPO, behavioral health and government contracts subsidiaries provide health benefits to more than 7 million individuals.  For more information on Health Net, Inc., please visit the company’s Web Site at www.healthnet.com


JOB SUMMARY:

 

Care Manager is responsible for the implementing the Care Management programs in multiple environments including Prior Authorization, Concurrent Review and Care Management. A patient advocacy approach with a seamless integration of services is required and must be balanced within the member’s benefit structure.  Emphasis will be placed on continuity of care, assisting members in obtaining access to care, and member education.  Participates in the continuum of care that addresses the ongoing needs of the member served by the care management process.


ESSENTIAL DUTIES AND RESPONSIBILITIES:

Provides Intensive Case Management for Managed Care beneficiaries.

Identifies patients appropriate for this service by evaluating high risk cases, intensity and complexity of services, health care costs, non-compliance issues and other triggers per policy.

Manages cases to ensure that the beneficiaries’ clinical needs are met at the most cost effective and clinically appropriate level.

Coordinates care between multiple providers.

Develops care plans in coordination with providers, patients, and families, as appropriate and assesses its effectiveness over time.

Identifies Potential Quality Indicators using criteria established by the QM department.

Coordinates with Medical Director when appropriate.

Communicates with both internal and external customers. Educates providers, members and beneficiaries regarding benefits.

Effectively analyzes complex cases; makes innovative use of available resources.

Performs data entry of authorizations and review-related material.

REQUIREMENTS:

 

Education:

College Degree

 

 

Certification/License:

Registered Nurse

Certified Social Worker or Clinical Psychologist with current licensure/certification

 

 

Experience:

Minimum two years case management or related experience.

Minimum three years psychiatric experience in acute, outpatient or Mental Health settings

 

Knowledge, Skills & Abilities:

Demonstrated ability to assess, evaluate and integrate clinical data

Computer literacy

Ability to function professionally under pressure

Self-starter with good problem solving skills

Ability to function as a team with cooperation, flexibility and willingness to assist others

Familiarity with Managed Care policies and procedures

Knowledge of Managed Care benefits and eligibility in this program

Familiarity with community resources

Ability to identify Potential Quality Indicators using criteria established by the QM department

Excellent planning, organizational and prioritization skills

Demonstrated communication and interpersonal skills 

OR
Any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.

 

Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
 
Health Net and its subsidiaries are an Equal opportunity/Affirmative Action Employer M/F/V/D.