Jobs in Macdona Texas
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Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by ensuring that members have access to all of the health care services they need in the most efficient and effective manner possible. Responsibilities include but are not limited to overseeing the allocation of resources, cost and quality of health care for members; coordinating care between the primary care physician, community resources, family and member; coordinating care across the health care continuum while monitoring and managing benefit utilization; and, collaborating with multi-disciplinary health care team members in identifying the educational and discharge needs of members.
EDUCATION/EXPERIENCE
Registered Nurse (RN) is required. Bachelor of Science in Nursing (BSN) or Master’s degree is preferred. Minimum three (3) years nursing, acute care, quality management or managed care experience is required. Basic knowledge of Medicaid, Medicare, community resources and alternate funding programs is desired. Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred.
LICENSURE/CERTIFICATION
Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required. Current certification from an appropriate professional agency, such as Case Management Society, is preferred.
The RN Service Coordinator-RN (RN-SC) contributes to the Long Term Services and Supports (LTSS) service coordination process by performing activities within the scope of licensure; provides supervision and direction to staff participating in Member’s cases following applicable state law and contract; develops, monitors, evaluates, and revises the Members’ care plans to meet Member’s needs, to optimize health care across the care continuum to enhance the Member's well-being, independence, integration in the community, and potential for productivity. The RN-SC conducts a holistic assessment of the Member's dynamics, needs, and preferences while providing education and health-related information to the Member, the Member’s Legal Authorized Representative (LAR), and the Member’s Support Network. Responsible for the coordination of STAR+PLUS Members' covered and non-capitated services, including acute and LTSS, while meeting the Member's physical, behavioral, functional, and psychosocial needs. Complies with policies, procedures, and protocols for establishing and maintaining good working relationships with co-workers, employees, patients, and guests.
EDUCATION/EXPERIENCE
Graduation from an accredited school of professional nursing or social work is required. BSN is preferred. Four (4) recent years of clinical experience preferred, which may include service coordination, case management, quality management, or managed care experience. Working knowledge of HMO standards, LTSS, and NCQA standards is preferred. Knowledge of Medicare and Medicaid HMO experience is preferred. Experience in meeting the needs of vulnerable populations who have chronic or complex conditions is required. Bilingual, English/Spanish, is preferred.
LICENSURE/ CERTIFICATION
A current, unrestricted license to practice professional nursing issued by the State of Texas is required. RUG Certification is required and must be obtained within 30 days of employment for all RN candidates.
Serves as a clinical expert, educator, and mentor for the Palo Alto Hospital. Functions in a team environment to provide support to clinical practice.
EDUCATION/EXPERIENCE
A Bachelor of Nursing degree is required. A national certification is required. Minimum of two years of full-time Registered Nurse experience required, five years of experience is preferred. Demonstration of experience in curriculum development and implementation of adult learning principles is required.
LICENSURE
State of Texas Licensure as a Registered Nurse is required. Current American Heart Association Basic Cardiac Life Support and Health Care Provider card is required.
Provides patient care as assigned by the registered nurse.
EDUCATION/EXPERIENCE
Recent experience in area of assignment or at least one year nursing experience is preferred. Current American Heart Association, Basic Cardiac Life Support and Healthcare Provider card required. Advanced Cardiac Life Support may be required based on location site.
LICENSURE
Current LVN licensure in the State of Texas is required.
University Hospital still serves as the primary teaching facility for UT Health San Antonio and is the premiere Level I trauma center for South Texas and the region’s only pediatric Level I trauma center. University Hospital is also home to the highest level neonatal intensive care unit and the region’s only Joint Commission accredited Comprehensive Stroke Center.
Why should you work for University Health?
Most up-to-date advancements in nursing
Level I Trauma Center
Teaching Hospital
Nurse Residency Program
RN Loan Repayment Program
Nationally certified nursing staff
Regionally, nationally and internationally recognized
Why Should You Apply?
- We offer exceptional pay and opportunities for advancement.
- Continuing Education
- Gym membership discounts
- Comprehensive benefits package including pet insurance
Requirements:
- BSN highly preferred
- Current RN license from the Texas Board of Nursing
- American Heart Association Healthcare Provider card
Under general supervision, the Clinical Transplant Coordinator I will use clinical management, consultation, education and research to promote quality care for the specific transplant patient populations. Supports and maintains the University Health System's policies, protocols, values and guest relations. Directly accountable to the Director and the Supervisor, Clinical Transplant Nurse. May direct activities and services provided by personnel in assigned area, such as Licensed Vocational Nurses, non-licensed nursing and secretarial support staff.
EDUCATION/EXPERIENCE
Graduation from an accredited school of nursing with an RN and one year of nursing experience required. Will develop a plan to attain a Bachelor's Degree in Nursing. Knowledge of transplant, health care trends, community and regional resources. An ability to establish cooperative working relationships with diverse groups and individuals, medical staff and other health care disciplines and understanding of the consultative process.
LICENSURE
Current RN licensure in the State of Texas. Current American Heart Association, Basic Cardiac Life Support Healthcare Provider certification required. Attain CITI research certification within six months from date of hire. (CITI certification is not required for coordinators in lung transplant, post-transplant, live donor transplant or disease management nurses).
Why USAA?
At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.
Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.
The Opportunity
It is all about learning and growing. Our Customer Service Claims Representative role may be a new career for you. There’s a lot to learn, but the pathway is mapped out and USAA is willing to invest in you! Our comprehensive, fully paid four-month training program includes all training materials, licensing costs, class discussions, hands-on training, e-learning modules, and the instructor led guidance will help you to support our members independently. We have new training classes starting every month.
Our in-office development program provides the training you need and the encouragement to create a proactive and independent support style to service our membership. After six months in-office, you’ll have the opportunity to work offsite 2 days a week. Military veterans and spouses are highly encouraged to apply. Relocation assistance is not available for this position.
Work schedules will vary and may include some nights and weekends. Schedules are assigned based on business need. Regularly scheduled shift hours that fall between 6 p.m. and 7 a.m. during the week, or between 6 p.m. Friday and 7 a.m. Monday are eligible for shift premium pay.
We are currently seeking dedicated professionals to work in our San Antonio office as a Customer Service Claims Representative. You will be part of an outstanding contact service center, where you will focus on providing claims service to members regarding the initial contact on all property First Notice of Loss (FNOL) claims. In addition, you will respond to status inquiries from various parties, document reported losses, set appropriate expectations, provide proactive communications, advice, and empathy to our members.
What you'll do:
Document First Notice of Loss by obtaining relevant information for effective claim investigation. Set up appropriate services, as needed, to proactively move claims forward to the furthest point in the process within scope of role and expectation.
Create loss reports, describe or verify coverage as appropriate, and initiate the most effective method of damage assessment to assign for file handling.
Assist with questions regarding the claims process and set expectations for next steps to help ensure claims are effectively resolved and accurately documented.
Resolve status inquiries and, when appropriate, route to handling adjuster.
Effectively operate in a fast-paced, high-volume, contact center environment taking back-to-back calls and navigating multiple systems and programs while maintaining an engaging member interaction that occurs across multiple communication channels.
Apply strong time management skills by closely adhering to assigned work schedule.
Embrace continuous improvement and development through coaching and collaboration with manager and team members.
Use strong call management skills by assisting members within a timely manner and limiting non-productive time.
May assign or initiate emergency services when required on specific claims.
Support workload surges and catastrophe (CAT) response operations as needed which may include potential weekends, and/or holiday work outside normal work hours.
Work various types of claim loss notices and inquiries, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.
Ensure risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.
What you have:
High School Diploma or GED
Ability to provide exceptional customer service for our members by using active listening, verbal, and written communication skills to communicate clearly, professionally, and empathetically.
Highly developed interpersonal skills to collaborate effectively in a fast-paced team environment.
Ability to prioritize and multi-task while navigating through multiple business applications.
Successful completion of a job-related assessment is required.
May require acquisition and maintenance of insurance adjuster license within 90 days. (USAA provides all materials and licensing fees.)
What sets you apart:
US military experience through military service or a military spouse/domestic partner
Compensation range: The hiring range for this position is: $43,750 to $45,750
Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.
Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.
The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.
Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.
For more details on our outstanding benefits, visit our benefits page on
Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.
USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
University Hospital still serves as the primary teaching facility for UT Health San Antonio and is the premiere Level I trauma center for South Texas and the region’s only pediatric Level I trauma center. University Hospital is also home to the highest level neonatal intensive care unit and the region’s only Joint Commission accredited Comprehensive Stroke Center.
Why should you work for University Health System?
Most up-to-date advancements in nursing
Level I Trauma Center
Teaching Hospital
Nurse Residency Program
RN Loan Repayment Program
Nationally certified nursing staff
Regionally, nationally and internationally recognized
Why Should You Apply?
- We offer exceptional pay and opportunities for advancement.
- Continuing Education
- Gym membership discounts
- Comprehensive benefits package including pet insurance
Requirements:
- BSN highly preferred
- Current RN license from the Texas Board of Nursing
- American Heart Association Healthcare Provider card
Why USAA?
At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.
Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.
The Opportunity
As a dedicated Senior Property Adjuster, you will work within defined guidelines and framework, investigate, evaluate, negotiate and settle complex property insurance claims presented by or against our members. You will confirm/analyze coverage, recognize liability exposure and negotiate equitable settlement in compliance with all state regulatory requirements. Adjusters recognize and empathize with members’ life events, as appropriate.
This hybrid role requires an individual to be in the office 3 days per week. This position can be based in one of the following locations: San Antonio, TX, Phoenix, AZ, Colorado Springs, CO, Tampa, FL or Chesapeake, VA. Relocation assistance is not available for this position.
The Inside Senior Property Adjuster role is a telephone concentrated environment without physical inspection of loss. This is an hourly, non-exempt position with paid overtime available. Training will be approximately 12 weeks, Monday – Friday and hours may vary by location. Upon successful completion of training, employees will transition to an eight-hour work shift ranging between 8:00 am – 5:30 pm (local time) Monday to Friday with availability for occasional evenings and weekends based on business needs.
What you'll do:
Proactively manages assigned claims caseload comprised of claims with moderate complexity damages that require commensurate knowledge and understanding of claims coverage.
Partners with vendors and internal business partners to facilitate moderate complexity claims resolution. May also involve external regulatory coordination to ensure appropriate documentation and compliance.
Investigates claim damages by conducting research from various sources, including the insured, third parties, and external resources. May identify and resolve potential discrepancies and identifies subrogation potential resulting from unusual characteristics.
Identifies coverage concerns, reviews prior loss history, determines and creates Special Investigation Unit (SIU) referrals, when appropriate. Determines coverage through analyzing investigation information involving moderate complexity policy terms and contingencies.
Determines and negotiates moderate complexity claims settlement. Develops recommendations and collaborates with management for determining settlement amounts outside of authority limits and accurately manages claims outcomes.
Maintains accurate, thorough, and current claim file documentation throughout the claims process.
Applies proficient knowledge of estimating technology platforms and virtual inspection tools; Utilizes platforms and tools to prepare claims estimates to manage moderate complexity property insurance claims.
Applies working knowledge of industry standards of inspection, damage mitigation and restoration techniques.
Serves as an informal resource for team members.
Recognizes and addresses jurisdictional challenges such as applicable legislation and construction considerations.
Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours.
May be assigned CAT deployment travel with minimal notice during designated CATs.
Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.
Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.
What you have:
High School Diploma or General Equivalency Diploma.
2 years relevant property adjusting and/or claims adjusting experience handling moderately complex claims or construction related industry/insurance experience.
Developing knowledge of residential construction.
Working knowledge of estimating losses using Xactimate or similar tools and platforms.
Demonstrated negotiation, investigation, communication, and conflict resolution skills.
Working knowledge of property claims contracts and interpretation of case law and state laws and regulations.
Proficient in prioritizing and multi-tasking, including navigating through multiple business applications.
May need to travel up to 50% of the year (local & non-local) and/or work catastrophe duty when needed.
Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts.
What sets you apart:
Experience handling water loss claims including water mitigation, water loss estimating and reconciliation
Experience desk adjusting property claims involving Dwelling, Other Structures, Loss of Use, and Contents using virtual technologies (Hosta, Hover, Xactimate, ClaimsX)
Experience handling large loss complex claims (i.e., water, vandalism, malicious mischief, foreclosures, earth movement, appraisal, collapse, etc.)
Experience with full file ownership handling claims from start to finish (FNOL, estimating, reviewing policy, making coverage decisions, settlement)
Insurance industry designations such as AINS, CPCU, AIC, SCLA (or actively pursuing)
Proficiency in Xactimate (Level 1 and/or Level 2 certification)
Experience in a call center environment
Currently hold an active Adjuster License
Bachelor’s degree
US military experience through military service or a military spouse/domestic partner
Physical Demand Requirements:
May require the ability to crouch and stoop to inspect confined spaces, to include attics and go beneath homes into crawl spaces.
May need to meet all USAA safe driving requirements including verification of driving record through MVR & possession of valid driver’s license.
May require the ability to lift a minimum of 35 pounds to include lifting a ladder in and out of the trunk of a car.
May require the ability to climb ladders and traverse roofs, this includes the ability to work at heights while inspecting roofs and attics.
Compensation range: The salary range for this position is: $63,590 - $114,450
USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).
Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.
Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.
The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.
Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.
For more details on our outstanding benefits, visit our benefits page on
Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.
USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Serves as a clinical expert, educator, and mentor for the Palo Alto Hospital. Functions in a team environment to provide support to clinical practice.
EDUCATION/EXPERIENCE
A Bachelor of Nursing degree is required. A national certification is required. Minimum of two years of full-time Registered Nurse experience required, five years of experience is preferred. Demonstration of experience in curriculum development and implementation of adult learning principles is required.
LICENSURE
State of Texas Licensure as a Registered Nurse is required. Current American Heart Association Basic Cardiac Life Support and Health Care Provider card is required.
