Case Mgr (Registered Nurse) - The Health Plan - remote

Position: Case Mgr (Registered Nurse) - The Health Plan - remote

Job ID: 160901

Location: US-TX-Houston

Department: Case/Disease Management

Talent Area: Registered Nurse

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

About Texas Children's Hospital

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.   To join our community of 14,000+ dedicated team members, visit for career opportunities. You can also learn more about our amazing culture at   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.


We are searching for a Case Manager -- 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 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 :

  • Comprehensively assesses member’s biophysical, psychosocial, environmental, discharge planning needs and financial status. Utilizes concepts of reflection and motivational interviewing with the member and the entire family unit, through phone conversations
  • Serves as a liaison with community organizations involved in the interests of the pediatric population
  • Accurately accesses own learning needs and developed strategies to meet them
  • Stays informed of current health care developments to provide safe, quality nurse home visiting services
  • Assess resource utilization and cost management: the diagnosis, past and present treatment; prognosis and goals (short and long term)


  • 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.
  • Diploma in nursing, Associate 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 required
  • Bachelor’s degree in nursing preferred
  • RN license from the Board of Nurse Examiners for the state of Texas required
  • Case Management certification preferred
  • 3 years’ clinical experience in pediatrics including home care, case management, managed care, or utilization review required
  • Bilingual in Spanish and English preferred
  • Experience in Case Management, Disease Management, Population Health, diabetes, asthma, and/or behavioral health preferred

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