Job Description

We are searching for a remote Case Manager -- someone who works well in a fast-paced setting. In this position, you will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual's health needs. This position provides comprehensive ongoing case management services by coordinating and managing care of high-risk members to meet multiple service needs across the continuum of care, ensure optimal member outcomes that address quality, service, customer satisfaction and cost effectiveness. This role also 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 • Comprehensively assesses, develops, implements, and monitors a comprehensive plan of care through an interdisciplinary team process in conjunction with the member and/or family in internal and external settings • Comprehensively assesses member’s biophysical, psychosocial, environmental, discharge planning needs and financial status • Utilizes concepts of reflection and motivational interviewing with the member and the entire family unit, through telephonic conversations • Communicates continually with members/families, medical staff, caregivers and providers to facilitate appropriate, timely, and cost-effective care • Serves as a liaison with community organizations involved in the interests of the adult and pediatric population • Maintains flexible schedule for some travel for Health Plan related functions, community volunteer opportunities, in-person team building events and meetings, health fairs, member and community educational outreach • Assists internal and external Member Services and Case Managers by serving as a communication link and providing education on member issues, authorization process, and status • Assists internal and external Member Services and Case Managers by serving as a communication link and providing education on member issues and authorization process and status • Identify and report quality of care and quality of services issues and refer to appropriate Quality Management staff as evidenced in Event Tracking system • Documents all activities and interactions in the electronic medical record system • Accurately accesses own learning needs and developed strategies to meet them • Stays informed of current health care developments to provide safe, quality nursing services • Assess resource utilization and cost management: the diagnosis, past and present treatment; prognosis and goals (short and long term)

Requirements • Bachelors degree, associate’s degree or technical diploma in nursing required • Bachelors in nursing (BSN) preferred • RN license from the Board of Nurse Examiners for the state of Texas required • Case Management Certification preferred • 3 years clinical experience in pediatrics including home care, case management, managed care or utilization review required • Home Health experience a plus but not required • Experience with STAR/CHIP is a plus • Bilingual in Spanish (or any language) and English is preferred

Job Info

Job Identification: 410587

Job Category: Registered Nurse

Posting Date: 2024-02-10T22:19:00 00:00

Degree Level: Associate Degree

Job Schedule: Full time

Job Shift: Day

Locations: 6330 West Loop South HOUSTON TX 77401 US