Bilingual Nurse Case Manager

Medix; Cockrell Hill (TX); Hybrid; USD 87,000 - 97,000; Full time

Job summary

Medix in Cockrell Hill, Texas is seeking a Bilingual Nurse Case Manager to join our outpatient care team. You will work with high-risk patient populations, manage chronic conditions, oversee transitions of care, and coordinate with providers, health plans, and community resources to deliver coordinated, high-quality care.

The role requires a Texas RN license (or compact), BSN or related degree preferred, 2 years of clinical RN experience and bilingual English/Spanish proficiency.

Qualifications

• Active RN license in Texas or compact license.
• Bachelor’s Degree in Nursing (BSN) or related field preferred.
• Minimum 2 years of clinical RN experience.
• Bilingual in English and Spanish strongly preferred.

Responsibilities

• Oversee chronic care management and care pathways for high-risk patients in outpatient setting.
• Perform comprehensive assessments to identify barriers to care and address social determinants of health (SDOH).
• Develop and adjust individualized care plans with the care team.
• Provide clinical triage via phone and route issues to the appropriate team members.
• Facilitate transitions of care from acute/post-acute settings and coordinate post-discharge resources.

Skills

Bilingual English/Spanish

RN experience

Clinical judgment

Cross-functional communication

Negotiation

Education

Bachelor's Degree in Nursing

Tools

EMR systems

Microsoft Office

Job description

Bilingual Nurse Case Manager (258378) Cockrell Hill, Texas

Salary: USD87000 - USD97000 per year

Work Schedule: Hybrid, Monday–Friday, 8:00 AM – 5:00 PM (2–3 days onsite per week)

Employment Type: Full-Time, Direct Hire

Position Overview

We are seeking a dedicated Bilingual Nurse Case Manager to join our multidisciplinary outpatient care team. In this role, you will work directly with high-risk patient populations, helping to manage chronic conditions, oversee smooth transitions of care, and navigate social determinants of health. You will serve as a core advocate and strategist for complex cases, collaborating closely with primary care providers, external facilities, health plans, and community resources to ensure coordinated, high-quality care.

Key Responsibilities

Complex Case & Chronic Care Management

Oversee chronic care management and clinical care pathways for high-risk, complex patient populations within an outpatient setting.

Conduct comprehensive physical, mental, and social risk assessments to identify barriers to care and address social determinants of health (SDOH).

Develop, implement, and adjust individualized care plans in collaboration with physicians, nursing staff, clinical pharmacists, and social workers.

Perform clinical triage via phone, providing immediate guidance or routing issues to appropriate care team members.

Transitions of Care & Readmission Prevention

Facilitate seamless patient transitions from acute and post-acute settings (hospitals, SNFs) back to the home or transitional facilities.

Apply evidence-based care transition models (such as the Coleman Model) to support patient recovery and reduce unnecessary re-hospitalizations.

Review and reconcile post-discharge medications alongside primary care providers and clinical pharmacists.

Coordinate essential post-discharge resources, including Home Health, Durable Medical Equipment (DME), hospice, and specialist referrals.

Ensure primary care or specialist follow-up appointments are scheduled within 7 days of discharge.

Obtain and review acute care records, diagnostic results, and discharge summaries to maintain continuity of care.

Interdisciplinary Collaboration & Quality Improvement

Partner with payers, external case managers, and community organizations to streamline resource allocation and eliminate care delivery barriers.

Track readmission data and participate in clinical performance improvement initiatives aimed at optimizing patient outcomes, fiscal efficiency, and patient satisfaction.

Document all assessments, phone interactions, and care plans accurately in the Electronic Medical Record (EMR) in a timely manner.

Utilize conflict resolution and advanced communication skills to navigate complex care scenarios and provider alignment.

Qualifications & Requirements

Education & Licensure

License: Active Registered Nurse (RN) License in Texas or an active Compact/Multi-State RN License (Required).

Education: Bachelor’s Degree in Nursing (BSN), Healthcare Administration, or a related field (Preferred).

Experience & Skills

Language: Bilingual in English and Spanish (Strongly Preferred).

Experience: Minimum 2 years of clinical RN experience.

Specialty Experience: Minimum 2 years in case management, chronic care management, utilization management, discharge planning, transitions of care, or value-based care programs.

Knowledge Base: Working knowledge of managed care reimbursement, Medicare Advantage, value-based care models, and post-acute community resources.

Technical Skills: Proficiency with Electronic Medical Record (EMR) systems and Microsoft Office Suite; comfortable using data to track care goals.

Soft Skills: Strong clinical judgment, time management, negotiation, and cross-functional communication skills.