RN Case Manager

Nexus Health Systems Ltd • Conroe, TX

5d • Onsite

About The Position

Nexus Neurorecovery Center – Conroe is seeking an experienced Registered Nurse (RN) Case Manager to coordinate care for patients with complex medical, neurological, and rehabilitative needs. Our Conroe campus provides specialized care for individuals recovering from brain injuries, neurological conditions, complex medical events, and other conditions requiring continued rehabilitation and long-term recovery support. This role is ideal for an RN with strong acute-care experience who understands how to coordinate complex cases from admission through discharge while balancing clinical needs, patient advocacy, utilization management, and available resources. The RN Case Manager serves as a critical link between the patient, family, physicians, nursing, rehabilitation teams, payors, and community providers to ensure care is coordinated, medically appropriate, and focused on successful outcomes.

Requirements

• Graduate of an accredited School of Nursing.
• Associate Degree in Nursing required.
• 3–5 years of acute-care hospital nursing experience.
• 2–3 years of acute hospital case management, utilization management, or complex discharge planning experience.
• Current, active, and unrestricted Registered Nurse (RN) license in the State of Texas.
• Strong clinical assessment and critical-thinking abilities.
• Ability to understand complex medical conditions and translate clinical information into effective care plans.
• Excellent communication and relationship-building skills with physicians, patients, families, payors, and interdisciplinary teams.
• Strong discharge planning and problem-solving capabilities.
• Ability to manage multiple complex cases and competing priorities.
• Strong organizational and time-management skills.
• Proficiency with electronic health records and case management systems.
• Knowledge of regulatory, accreditation, utilization management, and professional practice standards.

Nice To Haves

• Bachelor of Science in Nursing (BSN) preferred.
• Experience managing complex medical/surgical, neurological, rehabilitation, or medically complex patient populations strongly preferred.
• Strong understanding of healthcare systems, utilization management, care coordination, discharge planning, and transitions of care.
• Experience working with insurance carriers/payors and obtaining or supporting continued-stay authorizations preferred.
• Experience with InterQual, Milliman, or other nationally recognized utilization criteria preferred.

Responsibilities

• Conduct comprehensive assessments of patients' medical, psychosocial, emotional, and discharge needs.
• Develop and continually update individualized care plans based on patient needs, clinical progress, and treatment goals.
• Coordinate care across physicians, nursing, rehabilitation, behavioral health, and other members of the interdisciplinary team.
• Participate in multidisciplinary rounds and lead multidisciplinary team conferences.
• Monitor patient progress and identify barriers that could impact treatment, length of stay, or discharge.
• Coordinate specialist consultations, diagnostic testing, equipment, and post-discharge services as appropriate.
• Prevent fragmentation or duplication of services by maintaining communication across the continuum of care.
• Conduct ongoing utilization reviews to ensure services remain clinically appropriate and medically necessary.
• Apply InterQual, Milliman, DRG, or other nationally recognized criteria when evaluating level of care and continued stay.
• Collaborate with physicians to ensure clinical documentation supports medical necessity.
• Refer appropriate cases to the Physician Advisor or Medical Director for additional review.
• Communicate with insurance carriers and other payors regarding authorization, medical management, and care transitions.
• Support appropriate length of stay while maintaining high standards of patient care.
• Promote responsible utilization of healthcare resources without compromising clinical outcomes.
• Begin discharge planning early in the patient's stay and continually reassess needs as the patient's condition changes.
• Coordinate safe transitions to the appropriate next level of care.
• Arrange necessary DME, home health, outpatient services, community resources, placement, and other post-discharge support.
• Identify and resolve barriers that could delay discharge.
• Educate patients and families regarding the care plan, discharge expectations, available resources, and next steps.
• Collaborate with external providers and community resources to promote continuity of care following discharge.
• Serve as an advocate for patients and families throughout the treatment process.
• Help patients and families understand their care plan and navigate complex healthcare decisions.
• Ensure patient preferences and individual needs are incorporated into care and discharge planning.
• Provide equitable case management and discharge planning regardless of insurance status.
• Maintain patient confidentiality and comply with HIPAA and all applicable regulatory requirements.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree