Case Manager

Texas Children's Hospital; Houston (TX); On-site; USD 60,000 - 75,000; Full time

Job summary

Texas Children's Health Plan is seeking a Case Manager to work in a fast-paced environment, assessing and coordinating care for pediatric members. The role involves home visits, care planning, and collaboration with families, clinicians, and community resources to meet health needs.

Ideal candidates hold an RN license (Diploma/Associate/Bachelor in Nursing) and have 3+ years of pediatric clinical experience, including home care, managed care, or utilization review.

Qualifications

• RN license required per Texas Board of Nursing.
• 3+ years in pediatrics including home care or managed care.
• Case management certification preferred.

Responsibilities

• Assess and plan care for pediatric members across biophysical, psychosocial needs.
• Conduct home visits and clinic/hospital visits as indicated.
• Coordinate with families, medical staff, and community resources.
• Educate providers on network policies and Medicaid requirements.
• Prepare outcome data and monitor improvement opportunities.

Skills

RN licensure

Case management

Pediatrics experience

Home health care

Education

Nursing degree (Diploma/Associate/Bachelor)

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.

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

About Us

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.