Case Manager, Registered Nurse – Field – Houston Methodist - The Woodlands Hospital, TX

CVS Health•Houston, TX

11d•$60,522 - $129,615•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 - Woodlands, requiring consistent in-person engagement with members, providers, and multidisciplinary care teams. Candidates must reside within reasonable driving distance of both facilities to support reliable on-site presence and timely care coordination.

Requirements

Active and unrestricted Registered Nurse License (RN) in Texas (TX)
Reliable transportation and the ability to consistently meet onsite, hospital based work requirements at Houston Methodist - Woodlands (up to 55-75%)
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 Microsoft Word, Excel, Outlook, PowerPoint, and proprietary clinical systems.
Efficient computer skills, including navigating multiple systems and keyboarding
Associate’s Degree in Nursing with equivalent clinical experience

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 in Nursing

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 - Woodlands, 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.