Case Manager, Registered Nurse – Field – Houston Methodist Hospital Main

CVS Health•Houston, TX

16d•Onsite

About The Position

This role supports the delivery of appropriate benefits and healthcare services by facilitating eligibility determination, promoting wellness activities, and advancing successful, timely health outcomes. The team develops, implements, and supports health strategies, policies, and programs that ensure effective care delivery and overall member wellness. Services span network management, clinical coverage, and evidence-based policies. The ACC Case Manager applies a collaborative, member-centered approach to assessment, care planning, coordination, evaluation, and advocacy to address the comprehensive health needs of individuals and families. This is an on-site, hospital-based role supporting members receiving care at Houston Methodist Hospital and requires consistent in-person engagement with members, providers, and multidisciplinary care teams. Candidates must reside within reasonable driving distance of the facility to support reliable on-site presence and timely care coordination.

Requirements

Active and unrestricted Registered Nurse (RN) License in Texas
3+ years of clinical experience, preferably with Medicare and Commercial populations
Ability to work independently within a hospital-based environment
Strong analytical, problem-solving, organizational, and communication skills
Proficiency in MS Word, Excel, Outlook, PowerPoint, and proprietary clinical systems.
Efficient computer skills, including navigating multiple systems and keyboarding.
Reliable transportation and the ability to consistently meet onsite, hospital-based- work requirements at Houston Methodist Hospital up to 50-75%
Associate’s Degree in Nursing with equivalent clinical experience
Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
Openness to learning new skills in the future as the workplace environment evolves

Nice To Haves

3+ year of experience in care management, discharge planning, or home health coordination
Willingness to obtain multi-state RN licensure (company supported)
National certification (CRC, CDMS, CRRN, COHN, or CCM)
Bachelor's Degree

Responsibilities

Serve as a liaison between members/clients, families, employers, providers, insurance carriers, and healthcare personnel as appropriate.
Implement and coordinate case management activities for catastrophic and chronically ill members across the continuum of care, including consultant referrals, home care, community resources, and alternative levels of care.
Interact with members/clients both telephonically and in person while working on-site at Houston Methodist Hospital, including meeting with members during inpatient admissions.
Assess medical, functional, and vocational status to develop and implement individualized plans of care that support optimal health outcomes, benefits eligibility, and timely return to work or baseline functioning.
Communicate effectively with stakeholders including medical providers, attorneys, employers, and insurance carriers.
Prepare timely and accurate documentation of all case management activities.
Collaborate with internal multidisciplinary teams to support optimal member outcomes.
Conduct outreach to treating physicians and specialists to support appropriate care planning.
Provide education and preventive guidance to promote best clinical outcomes.
Apply applicable laws, regulations, and payer requirements related to rehabilitation and case management services.
Monitor member progress toward desired outcomes and adjust care plans as needed.
Develop proactive strategies to address complex needs and support both short- and long-term wellness outcomes.