Case Manager

 
Position: Case Manager

Job ID: 142031

Department: STAR KIDS CARE 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 to utilizing a collaborative approach, the nurse case 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.

 

 

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Responsibilities :

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.

 

Assessment: Comprehensively assesses member’s biophysical, psychosocial, environmental, discharge planning needs and financial status.

Participates in planning and coordinating services across the continuum of care and documents this plan in designated system. Provides education to members regarding the TCHP network, access to physicians and specialists and other providers, TCH IDS and community resources as well as basic health information. Assists in development of disease specific case management programs as indicated for Texas Children’s

Health Plan members.

 

 



Qualifications:

The formal education and experience required for completely satisfactory performance in this job is:

  • A Bachelor of Science in Nursing (preferred), Associate Degree in Nursing, or Diploma in Nursing

 

 

  • RN License issued by the Board of Nurse Examiners for the State of Texas.

 

 

  • Minimum three (3) years of clinical experience in pediatrics including the following areas of expertise: home care, case management, managed care or utilization review.

 

 

 

The following is preferred:

  • Case Management Certification.

 

 

Bilingual in Spanish and English.



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