Manager of Case and Disease Management

 
Position: Manager of Case and Disease Management

Location: US-TX-Bellaire

Shift: 8am - 5pm

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 14,000+ 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 and Disease Management Manager - someone who is passionate about case managment. In this position, you’ll supervise and provide social case management services to Health Plan members and to continually develop the identification outreach and delivery of social supports as needed to respond to the strategic goals of the organization.

 

Think you’ve got what it takes?



Responsibilities :

  • Plan, develop, organize, direct implement and monitor a coordinated approach to social case management services for members under the guidelines which responds to and meets the obligation of contractual agreements and legislative regulations
  • Provides supervision of social case management services
  • Provides a social case management for members including assessment, planning, implementation and evaluation of educational and social service related options
  • Proactively identifies members in need of social case management through clinical referral, staff referrals, consultation predictive modeling, PCP, parents, and other internal
  • Comprehensively assesses member’s psychosocial, environmental, discharge planning needs, readiness to change, understanding of resources, and financial status
  • Ensures the provision of community services and action made on referrals, advocate on behalf of members and families on an ongoing basis across the continuum of care
  • Identifies problems / barriers / opportunities for intervention and provides for resolution, revision of plans on an ongoing basis
  • Routinely assesses member’s status and progress; if progress is static or regressive, determines the reason and proactively encourages appropriate adjustments in the care plan, providers and/or services to promote better outcomes
  • Develops approaches, policies and programs for social case management which are based on the IDS goals and objectives and which meet performance goals
  • Ensures the delivery of cost effective, community-based and culturally sensitive social case management interventions and continuous quality improvement monitoring
  • Collaborates to ensure member outcomes that address values of quality, service and cost effectiveness
  • Communicates and collaborates with members and providers with the goals of providing education on case management and community resources and to facilitate appropriate, timely, and cost effective care 


Qualifications:

  • Bachelor’s Degree in Health Education, Social Work, Nursing or Public Health
  • One of the following:
    • Licensed Clinical Social Worker (LCSW) issued by the Texas State Board of Social Work Examiners
    • Licensed Master Social Worker (LMSW) issued by the Texas State Board of Social Work Examiners
    • Registered and currently licensed by the Board of Nurse Examiners for the State of Texas
  • A minimum of five (5) years of experience in health delivery or a managed care organization
  • Case Management Certification preferred

Preference for this position includes at least 2 years experience in a Management Role.



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