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
We are searching for a Manager in Case/Disease Management to supervise and provide case management services to Texas Children's Health Plan members and to continually develop the identification, outreach, and delivery of medical and behavioral health care coordination support as needed to respond to the strategic goals of Texas Children's Health Plan. Primary focus will be on design and implementing programs for disease management and behavioral health, including but not limited to Asthma , Diabetes, and Behavioral Health.
Think you have what it takes?
• innovative and creative, along with strong technical skills with data and analysis
• Applying highly technical principles, concepts and techniques central to the nursing profession in the case management process and general managed care and specifically with complex pediatrics and disease management.
• Must have evidence of leadership, creativity, integrity and initiative and sound problem solving skills
• Analyzing data to provide focused interventions based on specific disease processes (e.g. asthma, diabetes, ADHD)
• Ability to operate a personal computer, word processing programs, fax machine, photocopier and multi-line phone
• Have excellent written and verbal communication skills, impeccable negotiating skills, and the ability to interact with a wide variety of individuals and handle several complex situations simultaneously
• Plan, develop, organize, direct implement and monitor a coordinated approach to case management services for TCHP members under the guidelines which responds to and meets the obligation of contractual agreements and legislative regulations
• Provides supervision of case management teams
• Facilitates orientation of staff to the department
• Provides supervision over disease management for TCHP members including assessment, planning and implementation and evaluation of educational social service related options
• Collaborate with local organizations involved with the interest of the pediatric population to represent TCHP intentions and provide information internally
• Supervises the completion of home visits and clinic or hospital visits with members when assessed to be indicated for care management needs
• Notifies providers of approved and denied services verbally and through written correspondence in accordance with written policy and procedures
• Communicates the utilization assessment needed to prove for appropriate levels of care during stays of illness and for continuity of care and needs.
• Serves as a liaison with community agencies and other groups and organization witch impact medical health services
• Maintains current knowledge an contacts with alternate sites for appropriate health care delivery within the community
Skills & Requirements
- Bachelor’s Degree in either Health Education, Social Work, Nursing or Public Health
- Registered Nurse
- 5yrs experience in health delivery or a managed care organization
- Disease Management and population health background
- Supervisory experience
- Pediatric population experience
- Certification in Case management
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