Case Manager (Registered Nurse) - Behavioral Health - The Health Plan

About Texas Children's Hospital

Summary:

Summary
We are searching for a Case Manager for Behavioral Health -- someone who works well in a fast-paced setting. In this position, you will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual's health needs. This position provides comprehensive ongoing case management services by coordinating and managing the care of high-risk members in order to meet multiple service needs across the continuum of care, ensure optimal member outcomes that address quality, service, customer satisfaction, and cost-effectiveness. This role also assists the member/member's family in coping with illness by optimizing the member's/family's self-care abilities and supporting their consumer rights.

Think you’ve got what it takes?

 Responsibilities
•    Assesses, develops, implements, and monitors a comprehensive plan of care through an interdisciplinary team process in conjunction with the member/family in internal and external settings
•    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
•    Serves as a liaison with community organizations involved in the interests of the maternity and pediatric population
•    Assists internal and external Member Services and Case Managers by serving as a communication link and providing education on member issues and authorization process and status
•    Completes all required annual education requirements and an annual interaction event with members
•    Identify and report quality of care and quality of services issues and refer to appropriate Quality Management staff as evidenced in Event Tracking system
•    Documents all activities and interactions in the electronic and event tracking systems

Requirements
Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s, unless approved for a medical or religious exemption
•    Associate’s degree, technical diploma or bachelor’s degree in Nursing required
•    BSN preferred
•    RN license from the Board of Nurse Examiners for the state of Texas required
•    3 years’ clinical experience in pediatrics including home care, case management, managed care, or utilization review
•    Behavioral Health experience preferred