Case Manager-Health Plan

 
Position: Case Manager-Health Plan

Job ID: 147413

Location: US-TX-Bellaire

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

Summary:

We are searching for a Case Manager – someone who works well in a fast-paced outpatient setting. This position as the nurse case manager will assess, plan, implement, monitor and evaluate the options and services required to meet an individual's health needs. You’ll provide comprehensive ongoing case management services to health plan members by coordinating and managing the care of high-risk members in order to meet multiple service needs across the continuum of care. This role will ensure optimal member outcomes that address quality, service, customer satisfaction, and cost-effectiveness. You’ll also assist 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 :

  • Assess, develop, implement and monitors a comprehensive plan of care through an interdisciplinary team process in conjunction with the members/families in internal and external settings 
  • Performs all necessary communication and documentation functions 
  • Collaborates with community health education/outreach organizations and providers to provide for the overall health promotion of members. 
  • Conducts provider and member education activities and oversees professional development 
  • Prepares and Monitors outcome data to assist in identification of improvement opportunities

 

 

 

 

 



Qualifications:

  • Associate degree, technical diploma, or bachelor’s degree in Nursing required 
  • RN – Licensed Registered Nurses from the Board of Nurse Examiners for the State of Texas 
  • 3 years of clinical experience in pediatrics including the following areas of expertise: home care, case management, managed care or utilization review required

 



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