Case Manager - Complex cases - The Health Plan

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 texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.  At Texas Children’s Hospital, diversity, equity, and inclusion are at the core of our values and mission for all of our patients and families that we serve. We are committed to providing a diverse and inclusive work environment for all faculty, staff and learners throughout our organization. We believe that each member of our one amazing team provides enrichment that allows us to create a lasting legacy for future employees of this great organization.   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.

Summary:

We are searching for a remote 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 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 home visits and clinic or hospital visits with members as indicated
• 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

Qualifications:

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

 

• Bachelors degree, associate’s degree or technical diploma in nursing required
• Bachelors in nursing (BSN) 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
• Experience with coordinating resources (food, housing, transportation) preferred
• Experience with home health, case management and/or managed care organizations is preferred
• Motivational interviewing and telephonic work experience is helpful

Apply Now 