Memorial Hermann Health System is seeking a Registered Nurse (RN) Case Management Level II for a nursing job in Houston, Texas.
Job Description & Requirements Specialty: Case Management
Discipline: RN
Duration: Ongoing
36 hours per week
Shift: 12 hours, days, nights
Employment Type: Staff
At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
Job Summary
Position is responsible for responding to inquiries from subscribers, providers and the client. Job Description Minimum Qualifications
Education: Some college preferred
Licenses/Certifications: (None)
Experience / Knowledge / Skills:
Three (3) years Customer Service or Claims processing experience in a TPA or HMO environment
Bilingual preferred
Principal Accountabilities
Efficiently and courteously responds to telephone inquiries from subscribers regarding benefit verification, claims issues, and eligibility.
Interprets plan coverage for subscribers and providers to determine correct level of benefit coverage.
Provides claim filing instructions when needed to subscribers and providers.
Provides telephone assistance to subscribers and providers, and verifies eligibility as required.
Promptly returns phone calls resulting from inquiries that require additional research.
Efficiently enters data simultaneously while listening attentively.
Provides a high degree of confidentiality/discretion and independent judgment.
Keeps workstations stocked and organized at all times.
Performs daily clerical duties, including sending faxes, making copies, and assisting in other areas.
Efficiently makes requested changes (temporary address changes, ID card requests).
Ensures safe care to patients, staff and visitors, adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
Other duties as assigned.
Memorial Hermann Health System Job ID #100175409. Posted job title: csr ii case management and support services
About Memorial Hermann Health System Company Overview:
Charting a better future. A future that’s built upon the HEALTH of our community. This is the driving force for Memorial Hermann, redefining health care for the individuals and many diverse populations we serve. Our 6,600+ affiliated physicians and 33,000+ employees practice the highest standards of safe, evidence-based, quality care to provide a personalized and outcome-oriented experience across our more than 270 care delivery sites. As one of the largest not-for-profit health systems in Southeast Texas, Memorial Hermann has an award-winning and nationally acclaimed Accountable Care Organization, 17* hospitals and numerous specialty programs and services conveniently located throughout the Greater Houston area. Memorial Hermann-Texas Medical Center is one of the nation's busiest Level I trauma centers and serves as the primary teaching hospital for McGovern Medical School at UTHealth. For more than 114 years, our focus has been the best interest of our community, contributing more than $411 million annually through school-based health centers and other community benefit programs. Now and for generations to come, the health of our community will be at the center of what we do – charting a better future for all.
*Memorial Hermann Health System owns and operates 14 hospitals and has joint ventures with three other hospital facilities, including Memorial Hermann Surgical Hospital First Colony, Memorial Hermann Surgical Hospital Kingwood and Memorial Hermann Rehabilitation Hospital-Katy.
Our Mission
Memorial Hermann Health System is a non-profit, values-driven, community-owned health system dedicated to improving health.
Our Vision
To create healthier communities, now and for generations to come.
Our Values
Community: We value diversity and inclusion and commit to being the best healthcare provider, employer and partner.
Compassion: We understand our privileged role in people's lives and care for everyone with kindness and respect.
Credibility: We conduct ourselves and our business responsibly and prioritize safety, quality and service when making decisions.
Courage: We act bravely to innovate and achieve world-class experience and outcomes for patients, consumers, partners and the community.
Benefits Dental benefits
Vision benefits
Employee assistance programs
403b retirement plan
Health Care FSA
Dependent Care FSA
School loan reimbursement