Case Manager Concurrent Review
Location: Pearland Administrative Office
Job Type: Full Time
Department: KS Plan Advantage-Managed Care
Kelsey-Seybold Clinic. Your Doctors for Life.
Since 1949, Kelsey-Seybold Clinic has served its patients with one goal in mind – combine the expertise of physicians in a variety of medical specialties, with the close personal care of a family doctor. Kelsey-Seybold is Houston’s largest community-based physician group, caring for more than 400,000 patients. With 19 clinic locations, we are growing to meet the health care needs of our diverse patient population. Our mission is to provide our team members with exceptional opportunities for professional and personal growth.
The Concurrent Review Case Manager is responsible for telephonic monitoring and the documentation of medical treatment and comparing it to established criteria to determine if treatment meets established guidelines. In addition, the Concurrent Review Case Manager monitors patients progress toward recovery for early identification of continuing care needs in an attempt to facilitate discharge for specified populations. This position works closely with Medical Management Physician leadership and various internal departments.
EDUCATION REQUIREMENTS & EXPERIENCE REQUIREMENTS
(A = basics; B = preferred)
A. Registered Nurse, ADN or Masters degree in Social Work
B. Certification in area of specialization, BSN, ACP certification
A. Five years nursing experience or three years experience in medical social work with an emphasis in case management of high risk patient population
B. Proven program development skills
A. TX RN license or TX LCSW license, valid Texas Driver’s license
B. Case Management Certification
A. Proven communication and problem solving skills; Computer literate
B. At least 2 years in area of specialization, 2 years of Case Management/Utilization Review experience
A. Managed Care knowledge