Case Manager

We’re searching for a Case Manager, someone who works well in a fast-paced setting. In this position, you’ll assess, plan, implement, monitor, and evaluate the options and services required to meet an individual’s health needs. You’ll be working closely with patients managing chronic conditions such as sickle cell disease, diabetes, and asthma, helping coordinate care, provide support, and ensure they receive the appropriate resources for ongoing treatment and wellness.

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, staff, home care staff, and other internal areas

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

Utilizes concepts of reflection and motivational interviewing with the member and the entire family unit, through phone conversations and face to face conversations

Completes home visits and clinic or hospital visits with members as indicated

Serves as a liaison with community organizations involved in the interests of the maternity and pediatric population

Educates providers on network compliance and policies and procedures of the Health Plan, managed care and Medicaid

Performs provider visits to discuss member program participation and adherence as agreed upon with leader

Accurately accesses own learning needs and developed strategies to meet them

Completes all required annual education requirements and an annual interaction event with Member

Prepares and monitors outcome data to assist in identification of improvement opportunities 
 

Diploma in nursing, or 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, or bachelor’s degree in nursing required

RN - Lic-Registered Nurses by Texas Board of Nursing or Nursing Licensure Compact required

Case management certification preferred

3 years of clinical experience in pediatrics including the following areas of expertise required: home care, case management, managed care or utilization review