Case Manager- Population Health

Texas Children's Careers • Bellaire, TX

1d

About The Position

We are searching for a Case Manager. Someone who will utilize 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.

Requirements

• Diploma in Nursing OR an Associate's degree Nursing or an associate’s degree in a related field accepted by the Texas Board of Nursing for the purposes of obtaining and maintaining an RN license OR Bachelor's Degree Nursing Licenses and Certifications Required
• RN - Lic-Registered Nurses Texas Board of Nursing or Nursing Licensure Compact required
• 3 years Clinical experience in pediatrics including the following areas of expertise: home care, case management, managed care or utilization review required.

Nice To Haves

• Case Management Certification preferred

Responsibilities

• Assesses, develops, implements and monitors a comprehensive plan of care through an interdisciplinary team process in conjunction with the member/family in internal and external settings
• Identification: 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.
• Planning and Coordination: Ensures for the provision of continuity of care needs as required and serves as advocate on behalf of members and families on an ongoing basis across the continuum of care.
• Implementation: Identifies problems/barriers/opportunities for intervention. Provides for resolution, revision of plans on an ongoing basis.
• Evaluation and Monitoring: Routinely assess member’s status and progress; if progress is static or regressive, determine the reason and proactively encourage appropriate adjustments in the care plan, providers and/or services to promote better outcomes.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees