Top 54 Nurse case manager Jobs in Edinburg Tx

Case Manager
Grand Terrace Rehabilitation and Health Care —McAllen, TX
- Full-time
- Mid-level
- Communication skills
- Commercial
2d
LVN Case Manager- FT - Days - Res Mgmt
DHR Health —Edinburg, TX
- Full-time
- Nursing
- LVN
- Hospital
RN Assessment Coordinator - PRN Nights -Rehab RN Assess Coord
DHR Health —Edinburg, TX
- PRN
- Nursing
- RN License
- Hospital
Clinical Care Nurse - RGV
Centerwell —Edinburg, TX
- $71,100 - $97,800 a year
- Full-time
- Spanish
- Nursing
- RN License
- Paid parental leave
- Paid holidays
RN Case Manager -FT - Days - Res Mgmt
DHR Health —Edinburg, TX
- Full-time
- Acute care
- Spanish
- Nursing
RN Transitional Care Navigator - FT - Days - Transitional Care Management
DHR Health —Edinburg, TX
- Full-time
- Nursing
- RN License
- Hospital
Case Manager RN
Mission Regional Medical Center —Mission, TX
- Day shift
- Nursing
- Hospital
- Computer literacy
- 401(k)
RN Transfer Coordinator - PRN - Days - Patient Intake Center
DHR Health —Edinburg, TX
- Weekends as needed
- Acute care
- Spanish
- Nursing
RN Case Manager
Mission Regional Medical Center —Mission, TX
- 8 hour shift
- Nursing
- RN License
- Hospital
- Health insurance
Bilingual Registered Nurse (RN) - Clinical Care Manager
Angels of Care Pediatric Home Health —Edinburg, TX
- Full-time
- Spanish
- Nursing
- Management
- Health savings account
- Health insurance
Quick Apply
RN Transfer - PRN - Varies - Patient Intake Care
DHR Health —Edinburg, TX
- Call employer
- Spanish
- Nursing
- RN License
Clinical Behavioral Manager - FT - Days - BH Admin
DHR Health —Edinburg, TX
- Full-time
- Nursing
- RN License
- Customer service
Registered Nurse (RN) Case Manager - Hospice - PRN
ATEX Healthcare Hospice —McAllen, TX
- PRN
- CPR Certification
- Nursing
- Management
Quick Apply
RN Transplant Coordinator- FT- Days-Renal Transplant
DHR Health —Edinburg, TX
- Full-time
- Nursing
- Patient monitoring
- RN License
Clinical Behavioral Manager - FT - Days - BH Flex (New Behavioral Hospital)
DHR Health —Edinburg, TX
- Full-time
- Nursing
- RN License
- BLS Certification
RN Clinical Liaison
Gentiva —McAllen, TX
- Full-time
- CPR Certification
- Nursing
- Management
Quick Apply
LVN - Clinical Liaison/Marketing - Full Time
Harbor Healthcare System —McAllen, TX
- Online Application
- LVN
- Pass drug screening
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
LVN Patient Navigator - FT - Days - Gen Surgeon Mob Dove 3rd Floor
DHR Health —McAllen, TX
- Full-time
- Spanish
- Surgery
- LVN
LVN QI Coordinator -PT Days - Clinical Certification
DHR Health —Edinburg, TX
- Part-time
- Acute care
- Spanish
- LVN
Advanced Practice Nurse - FT - Days - Research - Rio Grande City
DHR Health —Edinburg, TX
- Full-time
- Spanish
- Nursing
- Patient monitoring
13d

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Case Manager

Grand Terrace Rehabilitation and Health Care -
McAllen, TX

Apply Now

Job Details

Full-time
2 days ago

Qualifications

Collaborate with healthcare professionals
Appeals
Care plan evaluation
Medicare
DME
Medical insurance coverage verification
Team leadership
Overseeing healthcare denial management
Mid-level
Community resource coordination in health services social work
Durable medical equipment (DME) coordination
MDS
Transitional care planning in clinical case management
Healthcare referral management
Case appeal in utilization management
Pre-authorization review for utilization management
Utilization management
Care coordination meetings experience
Clinical program data analysis
Clinical outcome improvement
Resource utilization in healthcare
Patient family and caregiver education
Multidisciplinary team collaboration for treatment planning
Concurrent review in utilization management
Meeting facilitation
Patient care leadership
Patient progress monitoring
Health insurance referral requirements
Clinical team leadership
Case referral

Full Job Description

Admissions and Authorization Management

Review referrals and clinical documentation to determine appropriateness for SNF admission.
Coordinate pre-admission assessments and payer eligibility verification.
Obtain and manage insurance authorizations for Medicare Advantage, Managed Care, Commercial, and other payer sources.
Collaborate with hospital discharge planners, physicians, and referral sources to facilitate and streamline care transition to SNF.
Ensure timely communication with payers regarding clinical updates and authorization requests.

Clinical Reimbursement and Care Coordination

Lead and coordinate resident care planning activities with the interdisciplinary team.
Participate in daily clinical meetings, utilization reviews, and care conferences.
Monitor resident progress toward established goals and discharge plans.
Identify barriers to care and implement interventions to improve outcomes.
Facilitate communication among residents, families, physicians, therapists, nursing staff, and managed care companies.
Section GG and PDPM Leadership
- Serve as the clinical champion and facilitator for initial and discharge Section GG function score meetings.
- Drive interdisciplinary collaboration between nursing, therapy, and MDS to ensure precise, accurate, and compliant functional scoring that reflects true patient care needs.

Utilization and Length of Stay Management

Monitor resident length of stay and utilization of services.
Conduct concurrent reviews to ensure medical necessity and continued skilled coverage.
Submit clinical updates and supporting documentation to managed care companies.
Track authorization expirations and ensure uninterrupted coverage.
Analyze payer trends and identify opportunities to optimize reimbursement and resident outcomes.
Utilization Defense: Utilize objective clinical and functional data to build robust clinical justifications for continued skilled stay, effectively communicating functional deficits to managed care payers during concurrent reviews.
Peer-to-Peer and Appeals Managements: Must have the clinical acumen to assist prepping the Medical Director for peer-to-peer reviews and execute expedited appeals when a managed care organization issues an inappropriate discharge.

Discharge Planning and Care Transitions

Coordinate with IDT on individualized discharge plans upon admission.
Coordinate safe and effective transitions to home, assisted living, long-term care, or other settings.
Arrange community resources, durable medical equipment, home health services, and follow-up appointments.
Educate residents and families regarding discharge expectations and available resources.
Monitor readmission risks and implement strategies to reduce avoidable hospitalizations.

Apply Now

Refine Your Search

nurse case manager jobs in edinburg tx

Case Manager

LVN Case Manager- FT - Days - Res Mgmt

RN Assessment Coordinator - PRN Nights -Rehab RN Assess Coord

Clinical Care Nurse - RGV

RN Case Manager -FT - Days - Res Mgmt

RN Transitional Care Navigator - FT - Days - Transitional Care Management

Case Manager RN

RN Transfer Coordinator - PRN - Days - Patient Intake Center

RN Case Manager

Bilingual Registered Nurse (RN) - Clinical Care Manager

RN Transfer - PRN - Varies - Patient Intake Care

Clinical Behavioral Manager - FT - Days - BH Admin

Registered Nurse (RN) Case Manager - Hospice - PRN

RN Transplant Coordinator- FT- Days-Renal Transplant

Clinical Behavioral Manager - FT - Days - BH Flex (New Behavioral Hospital)

RN Clinical Liaison

LVN - Clinical Liaison/Marketing - Full Time

LVN Patient Navigator - FT - Days - Gen Surgeon Mob Dove 3rd Floor

LVN QI Coordinator -PT Days - Clinical Certification

Advanced Practice Nurse - FT - Days - Research - Rio Grande City

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