Case Manager

Socket.dev; Bellaire (TX); On-site; USD 70,000 - 100,000; Full time

Job summary

Texas Children's Health Plan seeks a Case Manager to assess, plan, implement, monitor and evaluate services for pediatric members in a fast-paced setting. The RN will collaborate with families and providers to coordinate care and support optimal outcomes.

The role requires RN licensure in Texas, pediatrics experience, and case management skills. Strong communication and care coordination are essential to serving STAR/Medicaid populations in the Houston area.

Qualifications

• RN license required by Texas Board of Nursing.
• 3 years of clinical pediatrics experience including home care or managed care is preferred.
• Case management certification preferred.

Responsibilities

• Proactively identifies and assesses pediatric members in need of case management.
• Coordinates care plans and discharge needs across providers and families.
• Educates providers on network policies and Medicaid requirements.
• Completes home visits and face-to-face assessments as indicated.
• Monitors outcomes and identifies opportunities for care improvements.

Skills

RN license

Case management

Pediatrics

Communication

Education

Nursing degree

Job description

We’re searching for a Case Manager, someone who works well in a fast-paced setting. In this position, you’ll assess, plan, implement, monitor and evaluate the options and services required to meet an individual's health needs.

Think you’ve got what it takes?

Job Duties & Responsibilities

• Proactively identifies members in need of case management through clinical rounds, medical management staff referrals, consultation with primary HMO staff, medical director and PCP, parents, staff, home care staff, and other internal areas
• Comprehensively assesses member’s biophysical, psychosocial, environmental, discharge planning needs and financial status
• Communicates continually with members/families, medical staff, caregivers, and primary HMO staff to facilitate appropriate, timely, and cost-effective care
• Utilizes concepts of reflection and motivational interviewing with the member and the entire family unit, through phone conversations and face to face conversations
• Completes home visits and clinic or hospital visits with members as indicated
• Serves as a liaison with community organizations involved in the interests of the maternity and pediatric population
• Educates providers on network compliance and policies and procedures of the Health Plan, managed care and Medicaid
• Performs provider visits to discuss member program participation and adherence as agreed upon with leader
• Accurately accesses own learning needs and developed strategies to meet them
• Completes all required annual education requirements and an annual interaction event with Member
• Prepares and monitors outcome data to assist in identification of improvement opportunities

Skills & Requirements

• Diploma in nursing, or associate’s degree in nursing or an associate’s degree in a related field accepted by the Texas Board of Nursing for the purposes of obtaining and maintaining an RN license, or bachelor’s degree in nursing required
• RN - Lic-Registered Nurses by Texas Board of Nursing or Nursing Licensure Compact required
• Case management certification preferred
• 3 years of clinical experience in pediatrics including the following areas of expertise required: home care, case management, managed care or utilization review

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.