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Case Manager

1 month ago

Houston TX United States Texas Children's Hospital Full time
Case Manager (RN) for Care Coordination - Health Plan

We are searching for a Case Manager (RN - Road Warrior) for Care Coordination - Health Plan - someone who will utilize a collaborative approach, asses, plan, implement, monitor and evaluate the options and services required to meet an individual's health needs. This nurse will provide 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. Think you have what it takes? * Proficiency in applying highly technical principles, concepts and techniques central to the nursing profession in the case management process and general managed care * Ability to comprehensively assess member/family medical needs, formulate a plan to help the member/family to meet these needs and provide ongoing evaluation and monitoring of those activities, education to members, families, providers and staff. * excellent customer service skills, advanced communication and interpersonal skills to assist medical staff, patients and families, clinical personnel, support and technical staff, outside agencies, and members of the community As part of our commitment to maintaining a safe and healthy workplace, all successful candidates will be required to undergo respiratory fit testing in compliance with occupational health and safety standards Minimum Qualifications * Diploma in nursing, associate's degree in 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 * RN license from the Board of Nurse Examiners for the state of Texas * Driver's license, must own transportation * Auto insurance * 3 years' clinical experience in pediatrics including home care, case management, managed care, or utilization review * BSN preferred * Bilingual/Spanish preferred, Responsibilities * Assisting the member/member's family in coping with illness by optimizing the member's/family's self-care abilities and supporting their consumer rights * 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 * Comprehensively assesses member's 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. * Documents all activities and interactions in the electronic and event tracking systems * Completes home visits and clinic or hospital visits with members as indicated * 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) * Accurately accesses own learning needs and developed strategies to meet them