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Registered Nurse

Case Manager (RN) for Care Coordination - Health Plan

Houston, TX, US
    Position: Case Manager (RN) for Care Coordination - Health Plan
    Talent Area: Registered Nurse
    Full/Part Time: Full time
    Location: Houston, TX, US
    Department: Care Coordination Admin
    Shift: 8a-5p
    Job ID: 413867

We are searching for a Case Manager (RN - Road Warrior) for Care Coordination - Health Plan - someone who will utilize a collaborative approach, asses, plan, implement, monitor and evaluate the options and services required to meet an individual's health needs. This nurse will provide comprehensive ongoing case management services to Texas Children's Health Plan members 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.   

Think you have what it takes? 

  • Proficiency in applying highly technical principles, concepts and techniques central to the nursing profession in the case management process and general managed care
  • Ability to comprehensively assess member/family medical needs, formulate a plan to help the member/family to meet these needs and provide ongoing evaluation and monitoring of those activities, education to members, families, providers and staff.
  • excellent customer service skills, advanced communication and interpersonal skills to assist medical staff, patients and families, clinical personnel, support and technical staff, outside agencies, and members of the community

As part of our commitment to maintaining a safe and healthy workplace, all successful candidates will be required to undergo respiratory fit testing in compliance with occupational health and safety standards

Minimum Qualifications

  • Diploma in nursing, 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 
  • RN license from the Board of Nurse Examiners for the state of Texas
  • Driver’s license, must own transportation
  • Auto insurance
  • 3 years’ clinical experience in pediatrics including home care, case management, managed care, or utilization review
  • BSN preferred 
  • Bilingual/Spanish preferred,

Responsibilities

  • Assisting the member/member's family in coping with illness by optimizing the member's/family's self-care abilities and supporting their consumer rights
  • 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, TCH staff, home care staff, and other internal TCHP areas
  • 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 and face to face conversations.
  • Documents all activities and interactions in the electronic and event tracking systems
  • Completes home visits and clinic or hospital visits with members as indicated
  • 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)
  • Accurately accesses own learning needs and developed strategies to meet them

     

About Texas Children’s

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.

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.

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