Care Manager-Complex Care

 
Position: Care Manager-Complex Care

Job ID: 146745

Location: US-TX-Houston

Department: Behavioral Health

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 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org

Summary:

Utilizing a collaborative approach, the nurse care manager will assess, plan, implement, monitor and evaluate the options and

services required to meet an individual's health needs. Provides 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. 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 :

  • Gathers relevant data and obtains further information by interviewing patient/family and performing a careful evaluation of the entire situation 
  • Plans and executes interdisciplinary and patient/family conferences as necessary to formulate and communicate the plan of care 
  • Maintains a professional relationship with payer representatives and assists in resolving any utilization issues that arise 
  • Assures timely performance of utilization management processes to maintain compliance with federal, state, and managed care contract regulations 
  • Participates in the orientation and training of new department members

 

 



Qualifications:

  • Associate’s degree in Nursing or a Diploma in Nursing required 
  • Bachelor’s degree in Nursing preferred RN – Licensed Registered Nurses from the State of Texas Nursing Board 
  • 3 years of experience as a Registered Nurse in an acute care or case management setting required 
  • Pediatric and case/care management experience preferred
  • CCM – Certificate for Certified Case Manager from the Commission for Case Manager Certification

 OR

  • FAACM – Fellowship in the American Academy of Case Management from The American Academy of Case Management/American Institute of Health Care Professionals

 OR

  • ACM – Certificate for Certified Accredited Case Manager from the American Case Management Association

OR

  • CMCN – Certificate for Certified Managed Care Nurse from the American Board of Managed Care Nursing (ABMCN) or the American Association of Managed Care Nurses (AAMCN)

OR

  • CMCP – Certificate for Certified Managed Care Professional from the American Board of Managed Care Nursing (ABMCN)

OR

  • CPHQ – Certificate for Certified Professional Healthcare Quality from the National Association for Healthcare Quality (NAHQ)

OR

  • CPHM – Certificate for Certified Professional in Healthcare Management from McKesson 

 

 



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