Case Management, Clinical Medicine, Contract Requirements, Documentation Standards, Identify Issues, Maintain Compliance, Medicaid, Member Orientation, Nursing, Nursing Credentials, Pediatrics, Problem Solving Skills, Process Improvement, Quality Assurance, Registered Nurse (RN), Regulations, Technical Writing, Time Management
Summary:
- Location: Must live in Lubbock, TX and surrounding area
- Work Mode: Remote and In-home visits up to 3x a week
- Duration: 6 months, possible extension or conversion
- Training: Monday - Friday 8am-5pm CST – 6 week course classroom setting – CAMERA ON – NO TIME OFF DURING TRAINING
- Work Shift: Monday - Friday 8am-5pm CST
Responsibilities:
- Provide comprehensive clinical care management and service coordination for members enrolled in STAR Kids and related LTSS programs
- Ensure members receive appropriate, timely, and medically necessary services
- Maintain compliance with Texas Medicaid requirements, contract deliverables, and audit standards
- Manage a complex member caseload and conduct clinical and service coordination reviews
- Complete required assessments and participate in interdisciplinary collaboration
- Ensure documentation meets regulatory standards
- Support issue resolution, provider coordination, member and caregiver education
- Identify care gaps proactively
- Participate in quality initiatives, audit preparation activities, process improvement efforts, and pilot implementations
Requirements:
- Education: Graduate from an Accredited School of Nursing or a Bachelor's degree
- Licensure: MUST have RN (TX)
- Experience: 2 years pediatrics experience, case management, RN required
- Reliable transportation required (Mileage will be reimbursed)
Preferred Skills:
- Bachelor's degree in Nursing preferred
- Work motivated with caseload/workload management skills
- Advanced documentation and technical system proficiency
- Ability to independently interpret and apply policy, troubleshoot effectively
AXEL01A
Axelon Services Corporation