Summary
Job Summary
Ensures members with complex needs receive coordinated, integrated care across medical, behavioral, and community-based services. Serving members enrolled in both Medicare and Medicaid through El Paso Health, this position coordinates benefits across both programs while working with Primary Care Providers (PCPs), specialists, and other providers to remove barriers to care. Conducts screenings and assessments, develops and maintains person-centered Individual Service Plans (ISPs), and monitors services to ensure they remain appropriate and effective as member needs evolve. Serves as a member advocate, educating and assisting members, caregivers, medical consenters, and partner agencies, including Health and Human Services (HHSC) and Department of Family and Protective Services (DFPS), in navigating the healthcare system, accessing available services and supports, and understanding their rights throughout the process.
Skills
1. Excellent verbal and written communication and interpersonal skills are required as demonstrated by past job experience.
2. Strong analytical, data management and computer skills.
3. Able to work with people of all social, economic, and cultural backgrounds.
4. Flexible, open-minded and adaptable to change.
5. Understanding of pre-acute and post-acute venues of care and community resources.
6. Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
7. Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients/families.
8. Computer and typing skills required.
9. Bilingual in English and Spanish is highly preferred.
Work Experience
Three years of professional nursing or social work experience is required. Previous experience as a Case Manager is highly preferred.
License/Registration/Certification
Current active and unrestricted license to practice as a Registered Nurse or Social Worker in the State of Texas is required.
Patient-Driven Payment Model (PDPM) for Long Term Care certification or Resource Utilization Group (RUG) certification is required to be obtained within 90 days of being in the position.
Certified Case Management (CCM) is preferred.
Education and Training
Bachelor degree in Nursing or Social Work is required.