Job Description

About Texas Children's Hospital

Founded in 1996, Texas Childrens Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org. Texas Childrens is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for a 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 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. 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 youve got what it takes?

Responsibilities :

* Comprehensively assesses members 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 phone conversations and face to face conversations.
* Completes home visits
* Serves as a liaison with community organizations involved in the interests of the maternity and pediatric population
* Maintains flexible schedule for travel, some evenings and weekends for member visits are optional, health fairs and member and community educational outreach
* Accurately accesses own learning needs and developed strategies to meet them
* Stays informed of current health care developments to provide safe, quality nurse home visiting services
* Assess resource utilization and cost management: the diagnosis, past and present treatment; prognosis and goals (short and long term)

Qualifications:

* Diploma in nursing, Associates degree in nursing or an associates degree in a related field accepted by the Texas Board of Nursing for the purposes of obtaining and maintaining an RN license required
* Bachelors degree in nursing preferred
* RN license from the Board of Nurse Examiners for the state of Texas required
* Drivers license required, own transportation
* Auto insurance required
* Case Management certification preferred
* 3 years clinical experience in pediatrics including home care, case management, managed care, or utilization review required
* Bilingual in Spanish and English preferred