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Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family. PCHP is a Medicaid Managed Care Organization servicing Texas Medicaid and CHIP in the Dallas Service Area. PCHP works to fulfill of our mission by empowering members to live healthier lives. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job—it’s a passion to serve and improve lives every day. Primary Purpose Identifies patient financial/medical eligibility, and develops, implements, monitors, and communicates individual patient plans of care to patients, families, and PHHS staff in order to ensure efficient, cost effective, quality patient care and compliance with program/PHHS policies and procedures. Minimum Specifications Education • Must be a graduate from an accredited school of nursing. Experience • Two (2) years of nursing experience Equivalent Education and/or Experience • None Certification/Registration/Licensure • Must have current, valid RN license or temporary RN license from the Texas Board of Nursing; or, valid Compact RN license., • Must have current healthcare provider BLS for Healthcare Providers certification from one of the following: • American Heart Association, • American Red Cross, • Military Training Network Skills or Special Abilities • Provides care to assigned patient population in accordance with the current State of Texas Nurse Practice Act, established protocols, multidisciplinary plan of care and clinical area specific standards., • Must be able to communicate and collaborate effectively with a diverse group of patients, families and healthcare staff., • Must be able to demonstrate a working knowledge of specific patient populations and be able to demonstrate knowledge of disease processes affecting this group., • Must be able to demonstrate a working knowledge of PC operations and the ability to use word processing software in a Windows environment., • Must be able to demonstrate a working knowledge of laws and regulations governing Medicare, Medicaid and other funding sources., • Must be self-directed and capable of priority setting and problem solving., • Must be able to demonstrate patient center/patient valued behaviors. Responsibilities 1. Conducts comprehensive assessment of patient in person, by telephone or by review of medical records. Gathers information from patient records and consults clinical team as needed. Identifies financial and medical status by reviewing patients diagnosis, recommended treatment, funding sources and special needs according to PHHS policies and procedures., 2. Develops patient plan of care and communicates the plan to patients and their families. May refer patients to identified primary care providers as needed. Oversees implementation of plan of care, ensures scheduling of appointments and provides relevant clinical information to primary care/ referring provider/specialty provider to ensure quality and continuity of patient care. Completes relevant documentation, intervening to optimize use of resources for cost effective healthcare., 3. Educates the patient on their diagnosis, treatment plan, referral process, clinic criteria, authorization process, payor/plan coverage, funding sources and community resources available to the patient., 4. Reviews referrals to primary/specialty clinics for appropriateness based on established clinic criteria. Reviews all available clinical data to ensure appropriate decision making. May facilitate required clinical and diagnostic work up to ensure that it is completed prior to approving the patient for a specialty appointment. Refers unfunded patients for financial counseling. Determines priority of appointment scheduling, contacting providers and others as needed for overbook approval., 5. Serves as a patient advocate, focusing on patients’ needs, rights, confidentiality and cultural preferences. Serves as a resource person for specific clinical and patient care issues, helping to negotiate desirable patient outcomes. Serves as a liaison between provider and patient/family to facilitate communication and services., 6. Uses a computerized database to verify and update patient financial information and complete appropriate documentation when applicable. Maintains knowledge regarding all payors/plans and potential funding sources. Communicates with other PHHS staff including pre-visit planning, registration, clinic staff, care management staff and providers to ensure reimbursement of clinic visits and procedures. Ensures authorization of visits to clinics for assigned patients as required. May refer outpatients who are out of network back to in network providers. Manages clinical denials, educating referring providers on clinic and payor requirements., 7. Promotes collaborative practice among patients, their families and multidisciplinary health care team members by attending meetings and acting as a consultative resource to physicians and PHHS staff. Maintains a positive relationship with all PHHS internal and external customers. Schedules inpatient and/or ambulatory operative procedures for assigned population based on medical necessity. Evaluates medical necessity of procedures ordered and ensures appropriate level of care for admissions. Coordinates pre-operative work up activities for assigned patients to reduce surgical delays/ cancellations. Ensures that each patient receives optimum care and that PHHS is adequately reimbursed for patient services., 8. Oncology Services Only: Will maintain current Commission on Cancer specific certification in the nurse’s specialty by an accredited certification program or will continue ongoing education by earning 12 cancer-related continuing education nursing contract hours per year or 36 cancer-related continuing education nursing contract hours each accreditation cycle (3 years). Parkland Community Health Plan (PCHP) prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion. Primary Purpose Parkland Community Health Plan's (PCHP's) Utilization Management (UM) Clinician is responsible for processing authorization requests for members requiring physical and/or behavioral healthcare for outpatient and inpatient service. UM responsibilities include but are not limited to processing of prior and concurrent review authorizations, discharge planning and transitions of care. Oversees the application of clinical guidelines in determining appropriateness of requested and continued healthcare services. Ensures that all clinical decisions are completed according to evidence based best practice guidelines and meets regulatory requirements. Seeks Medical Director review of cases not meeting criteria and monitors time frames for decision making and notifications of decision. Minimum Specifications Education • Bachelor's degree in Nursing; or Master's Degree in Social Work or a related field required., • If serving physical health populations, graduation from an accredited school of nursing is required. Experience • 3+ years of acute clinical nursing or medical management experience required. If serving behavioral health populations, at least three 3+ years of clinical social work or behavioral health experience required., • 3+ years of experience in Texas Medicaid, Medicaid, or a Medicaid managed care organization or health plan preferred., • 1+ year experience with the implementation of utilization management policies, procedures, and protocols for physical health and/or behavioral health services and knowledge of utilization management and case management principles is preferred., • Experience managing pediatric population with complex PH/BH conditions preferred., • Experience in Texas Medicaid and NCQA is preferred. Certification/Registration/Licensure • If primarily serving members with physical health needs, current and unrestricted licensure as a RN in the State of Texas required., • If primarily serving members with behavioral health needs, must have and maintain an unrestricted license such as a RN, LPC, LMFT, or LCSW in the State of Texas. Skills or Special Abilities • Knowledge of community resources, local service systems including indigent physical health and/or behavioral health systems., • Knowledge of utilization management and case management principles., • Understanding of utilization management principles, objectives, standards and methods, and of program policies and procedures., • For those reviewing BH authorizations, demonstrate knowledge and utilization of evidence-based practices relevant to population served (persons who have experienced trauma, members with substance use disorder, members with serious mental illness or serious emotional disturbance)., • Competency in prior and concurrent review authorization functions including application of criteria and timelines., • Demonstrated ability to analyze clinical information and accurately apply clinical criteria., • Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines. Ability to communicate complex information in understandable terms. Proven history of effective communication and counseling skills, • Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization., • Excellent analytical and problem-solving skills., • Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities., • Ability to write clearly and succinctly with a high level of attention to detail., • Proficient computer and Microsoft Office skills. Ability to learn new software programs., • Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. - Familiar with InterQual and Texas Medicaid Provider Procedures Manual and utilization guidelines., • Solid understanding of managed care and medical terminology., • Knowledge of and competence in use of UM software., • Foster strong, positive, and effective working relationships with inter-system and intra-system team members, encouraging and supporting interaction among various team members across organizational lines. Responsibilities • Care Coordination and Clinical Review Performs clinical utilization reviews of pre-authorization, concurrent and retrospective requests per clinical information submitted by providers using clinical criteria for medical necessity and appropriateness of care., • Approves services or forwards requests to the appropriate medical director for further review, as appropriate. Performs utilization management functions competently and adheres to the guidelines for authorization turn-around times., • Reviews clinical service requests from members or providers using evidence based clinical guidelines, analyzes clinical information and correctly applies clinical criteria. Requests additional information from members or providers in a timely manner and makes referrals to other clinical programs as needed., • Identifies members that are high risk or who have conditions that may need service coordination or disease management and facilitates appropriate referrals. Works collaboratively with provider network and health services team to coordinate member care., • Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care services. Answers utilization management directed telephone calls, managing them in a professional and competent manner., • Conducts ongoing availability, monitoring, and oversight of non-clinical staff activities. Uses effective relationship management, coordination of services, resource management, education, patient advocacy and related interventions to assure appropriate levels of care are received by members. Identifies and utilizes appropriate alternative and non-traditional available resources in managing cases., • Documentation Provides accurate and complete documentation along with an explanation of the rationale that was used to approve requests. Documents and maintains clinical information in health management systems ensuring all pertinent information is entered in a timely manner and in accordance with department guidelines., • Performs medical necessity documentation to expedite approvals and ensure that appropriate follow up is performed., • Regulatory Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements., • Professional Accountability Promotes and supports a culturally welcoming and inclusive work environment. Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values. Adheres to organizational policies, procedures, and guidelines., • Completes assigned training, self-appraisal, and annual health requirements timely. Adheres to hybrid work schedule requirements. Attends required meetings and town halls., • Recognizes and communicates ethical and legal concerns through the established channels of communication. Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.

Title: Resource Clinical Liaison (RN, PT, OT, SLP) - Inpatient Rehab Job Type: Full Time Location: Based in the Dallas-Fort Worth area Your experience matters! At Lifepoint Health, we are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. Here, you’re not just valued as an employee, but as a person. Here’s what makes us stand out: • Specialized Rehabilitation Programs: Tailored care for patients recovering from stroke, brain injury, spinal cord injury, amputation, orthopedic trauma, and other neurological or complex conditions., • Intensive Therapy Model: Patients typically receive at least three hours of physical, occupational, and/or speech therapy per day, five days a week, under the supervision of a rehabilitation physician., • State-of-the-Art Facility: Offers modern therapy equipment, private rooms, and a dedicated team focused on maximizing recovery and quality of life., • 24/7 Medical Support: Around-the-clock nursing and physician oversight ensure continuous care and safety throughout the rehabilitation process. As a Resource Clinical Liaison joining our team, you’re embracing a vital mission dedicated to making communities healthier. Join us on this meaningful journey where your skills, compassion, and dedication will make a remarkable difference in the lives of those we serve. How you'll contribute Build and maintain referral relationships to drive appropriate admissions to the hospitals. Coordinate the intake and pre-admission screening process, conduct on-site clinical assessments to determine suitability for acute rehabilitation, educate patients/families on services and participation requirements, and serve as the primary external contact for case managers, discharge planners, physicians, and payors. Travel 95% including out of the area. Essential Functions • Assist and coordinate the intake and pre-admission screening process., • Perform on-site clinical assessments (typically at referring facilities) to determine appropriateness for admission., • Educate patients and families on rehabilitation options, level of care, and expectations for participation., • Serve as the initial contact for external case management, discharge planners, payors, and hospital partners., • Conduct face-to-face, in-service educational visits with physicians, case managers, and other professionals., • Inform and educate community decision-makers about the hospital and acute rehabilitation services to develop census through direct outreach., • Document screenings, decisions, and communications accurately and timely in EMR and tracking systems., • Perform other duties as assigned. Additional Information Role involves weekly travel to referring facilities and community partners; valid driver’s license and clean driving record required. Success measures include timeliness of screenings, conversion rates, and quality of referral relationships. Works closely with admissions, nursing, therapy, and case management to ensure smooth transitions and payer authorization compliance. Education: Bachelor’s degree preferred. Licensure/Certification: Current clinical licensure required (RN, PT, OT, SLP) per state requirements. Experience: Prior marketing/sales experience in inpatient rehab required; prior clinical experience with demonstrated assessment skills and EMR proficiency preferred. Skills: Excellent oral and written communication, strong interpersonal and presentation skills, customer relationship building, sound clinical judgment, organization/time-management, and basic computer/data-entry proficiency.

Description Summary: The RN Navigator Home Health Review monitors home health patients to ensure patients continue to meet the CMS criteria for services. The RN Navigator makes recommendations to primary care providers regarding ongoing services. The RN Navigator facilitates communication and coordi

Requirements for Registered Nurses (RNs). Current, active Texas RNlicense. With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatric health service

The RN Navigator Senior will manage the length of service, promote efficient utilization of resources, and ensure that a well-organized and safe plan of care is established for every patient. Effectively prioritizes patients with the market leaders who benefit the most from care management programs.

Current, active Texas RNlicense. With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatric health services, including pediatric nursing and therapi

Plans and implements educational activities to meet identified learning needs, utilizing adult education principles. Requirements: Associate's Degree in Nursing RN License in state of employment or compact BLS Work Schedule: 8AM - 5PM Monday-Friday Work Type: Full Time.

Current, active Texas RNlicense. With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatric health services, including pediatric nursing and therapi

RN License in state of employment or compact. Assess learning needs and provides education to patients, family members and/or care givers; identify issues and resources.

Responsibilities for Registered Nurses (RNs). Requirements for Registered Nurses (RNs). Current, active Texas RNlicense.

Assess learning needs and provides education to patients, family members and/or care givers; identify issues and resources. RN License in state of employment or compact.

Benefits forRegistered Nurses (RNs). Responsibilities for Registered Nurses (RNs). Requirements for Registered Nurses (RNs).

Assess learning needs and provides education to patients, family members and/or care givers; identify issues and resources. RN License in state of employment or compact. All newly hired experienced RNs must attend New Nurses Orientation within the first 30 days of hire.

Benefits for Registered Nurses (RNs). Responsibilities for Registered Nurses (RNs). Requirements forRegistered Nurses (RNs).

All newly hired experienced RNs must attend New Nurses Orientation within the first 30 days of hire. All newly licensed RNs may participate in a residency program or other specific orientation. Assess learning needs and provides education to patients, family members and/or care givers; identify issu

Benefits forRegistered Nurses (RNs). Responsibilities for Registered Nurses (RNs). Requirements for Registered Nurses (RNs).

Plans and implements educational activities to meet identified learning needs, utilizing adult education principles. RN License in state of employment or compact.

Responsibilities for Registered Nurses (RNs). Requirements forRegistered Nurses (RNs). Current, active Texas RNlicense.

Assess learning needs and provides education to patients, family members and/or care givers; identify issues and resources. RN License in state of employment or compact. All newly hired experienced RNs must attend New Nurses Orientation within the first 30 days of hire.

With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatric health services, including pediatric nursing and therapies, ABA therapy, nursing, Family

RN License in state of employment or compact. All newly hired experienced RNs must attend New Nurses Orientation within the first 30 days of hire. Assess learning needs and provides education to patients, family members and/or care givers; identify issues and resources.

Benefits for Registered Nurses (RNs). Responsibilities for Registered Nurses (RNs). Requirements for Registered Nurses (RNs).

Assess learning needs and provides education to patients, family members and/or care givers; identify issues and resources. RN License in state of employment or compact.

Current, active Texas RNlicense. With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatric health services, including pediatric nursing and therapi

Plans and implements educational activities to meet identified learning needs, utilizing adult education principles. RN License in state of employment or compact.

Interested in helping patients navigate our healthcare system more efficiently and effectively for their benefit? Have passion for injured workers? We are hiring a full time, fully benefited Field Case Manager to meet with patients at Physician offices during their recovery process.We are willing to

Assess learning needs and provides education to patients, family members and/or care givers; identify issues and resources. Ensures that all equipment and related supplies are in proper working order prior to use to ensure patient safety. Relates examples of mis-readings or misinterpretations and le

Benefits for Registered Nurses (RNs). Responsibilities for Registered Nurses (RNs). Requirements forRegistered Nurses (RNs).

Assess learning needs and provides education to patients, family members and/or care givers; identify issues and resources. RN License in state of employment or compact.

With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatric health services, including pediatric nursing and therapies, ABA therapy, nursing, Family

The RN Navigator Home Health Review monitors home health patients to ensure patients continue to meet the CMS criteria for services. The RN Navigator makes recommendations to primary care providers regarding ongoing services. The RN Navigator facilitates communication and coordinates care with physi

With locations in Colorado, Texas, Arizona, Nevada, Florida, Oregon, Washington, California, Wyoming, New Jersey, Delaware, and Pennsylvania, the Care Options for Kids Community offers a wide range of pediatric health services, including pediatric nursing and therapies, ABA therapy, nursing, Family

Assess learning needs and provides education to patients, family members and/or care givers; identify issues and resources. RN License in state of employment or compact. All newly hired experienced RNs must attend New Nurses Orientation within the first 30 days of hire.

Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate. Registered Nurse Care Manager / Case Management (RN) at ScionHealth summary:. Able to organize tasks, develop action plans, set priorities and funct

Plans and implements educational activities to meet identified learning needs, utilizing adult education principles. RN License in state of employment or compact.

Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate. Registered Nurse Care Manager / Case Management (RN) at ScionHealth summary:. Able to organize tasks, develop action plans, set priorities and funct

Assess learning needs and provides education to patients, family members and/or care givers; identify issues and resources. Ensures that all equipment and related supplies are in proper working order prior to use to ensure patient safety. Relates examples of mis-readings or misinterpretations and le

Dialysis Registered Nurse / RN. The Dialysis Registered Nurse / RN provides professional nursing care to patients of the Hospital and under the license of the Hospital in need of renal replacement therapy. Current Registered Nurse / RN license in the state of practice required.

All newly licensed RNs may participate in a residency program or other specific orientation. Assess learning needs and provides education to patients, family members and/or care givers; identify issues and resources. RN License in state of employment or compact.

Current Registered Nurse / RN license in the state of practice required. Dialysis Registered Nurse / RN. The Dialysis Registered Nurse / RN provides professional nursing care to patients of the Hospital and under the license of the Hospital in need of renal replacement therapy.

The RN Navigator makes recommendations to primary care providers regarding ongoing services. The RN Navigator facilitates communication and coordinates care with physicians, the providers’ clinic, hospital facilities, family, caregivers, and other community healthcare providers. RN license in the

Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate. Able to organize tasks, develop action plans, set priorities and function under stressful situations. Registered Nurse Care Manager / Case Managemen

Let us show you how you can expand your professional experience as a CCM, CRRN, COHN, and CDMS. Knowledge of laws and regulations governing delivery of rehabilitation services. Meet top doctors of their specialty and learn from them directly.

Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate. Registered Nurse Care Manager / Case Management (RN) at ScionHealth summary:. Able to organize tasks, develop action plans, set priorities and funct

Let us show you how you can expand your professional experience as a CCM, CRRN, COHN, and CDMS. Knowledge of laws and regulations governing delivery of rehabilitation services. Meet top doctors of their specialty and learn from them directly.

Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate. Able to organize tasks, develop action plans, set priorities and function under stressful situations. Registered Nurse Care Manager / Case Managemen

Earn up to $750 per week part-time working from home. This is a great way to earn additional income from the comfort of your home. Then be ready to discuss PRIOR to meeting date.