Case Management Nurse 258378

Medix™; Dallas (TX); Hybrid; USD 75,000 - 95,000; Full time

Job summary

Medix™ is seeking a dedicated Bilingual Nurse Case Manager to join our outpatient care team in Texas. You will manage high‑risk patient populations, coordinate transitions of care, and serve as an advocate for complex cases alongside physicians, pharmacists, and social workers.

You will assess physical, mental, and social health factors, create individualized care plans, and ensure follow‑up and resource navigation to improve outcomes and reduce readmissions.

Qualifications

• Active RN license in Texas or compact/multi-state license.
• Bachelor’s degree in Nursing (BSN) or related field preferred.

Responsibilities

• Oversee chronic care management and clinical care pathways for high‑risk, complex populations in outpatient settings.
• Conduct comprehensive physical, mental, and social risk assessments to identify barriers to care and address social determinants of health (SDOH).
• Develop and adjust individualized care plans with physicians, nurses, pharmacists, and social workers.
• Perform clinical triage via phone, providing timely guidance or routing to the appropriate team.

Education

BSN (Bachelor of Science in Nursing)

Tools

EMR systems

Microsoft Office Suite

Job description

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 & Licenses

• 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.