Senior Complex Case Manager - RN (Managed Care)

Community Health Choice, Inc.; Houston (TX); Hybrid; USD 75,000 - 120,000; Full time

Job summary

Community Health Choice, Inc. in Texas seeks a Complex Case Manager (CCM) to identify, coordinate, and evaluate medical services for chronically ill members across acute and non-acute settings.

The CCM will perform telephonic assessments, create care plans, authorize services, and collaborate with PCPs, specialists, and care teams to optimize outcomes. RN with Texas license required; 5 years acute care, 2 years managed care preferred; CCM eligibility within 18 months.

Qualifications

• RN with unrestricted Texas license; CCM required or must be obtained within 18 months.
• 5 years clinical experience in an acute care setting; 2 years insurance/managed care experience preferred.
• Proficiency with Microsoft Office (Word, Excel, Outlook).

Responsibilities

• Identify, monitor, and evaluate delivery of health services for chronically ill members.
• Coordinate care with members, PCPs, and specialists to determine appropriate interventions.
• Authorize services across levels of care and ensure timely data entry and approvals.
• Refer to community resources and meet performance/quality metrics.

Skills

MS Word/Office

Education

RN license in TX

CCM eligibility in 18 months

Tools

Microsoft Office

Job description

Community Health Choice, Inc. in Texas seeks a Complex Case Manager (CCM) to identify, coordinate, and evaluate medical services for chronically ill members across acute and non-acute settings.

The CCM will perform telephonic assessments, create care plans, authorize services, and collaborate with PCPs, specialists, and care teams to optimize outcomes. RN with Texas license required; 5 years acute care, 2 years managed care preferred; CCM eligibility within 18 months.