Primary Nurse Case Manager

24 hours ago


Houston, Texas, United States Health Care Service Corporation Full time

**Job Summary**

Health Care Service Corporation (HCSC) is seeking a highly skilled and dedicated Primary Nurse Case Manager to join our team. As a Primary Nurse Case Manager, you will play a critical role in ensuring that our members receive high-quality, cost-effective care.

**Key Responsibilities:**

  • Perform concurrent review, discharge planning, and care coordination for members with complex or catastrophic health conditions.
  • Identify alternate treatment programs and consult with physicians, providers, and other resources to evaluate options and services required to meet an individual's health needs.
  • Promote quality and cost-effective outcomes by coordinating care and services with healthcare providers and other stakeholders.
  • Serve as a liaison to physicians and members, providing education and support to ensure seamless care transitions.
  • Develop and implement individualized care plans that address the unique needs and goals of each member.
  • Collaborate with internal stakeholders, including case management, disease management, and utilization management teams, to ensure comprehensive care coordination.
  • Stay up-to-date on the latest clinical guidelines, policies, and procedures to ensure that care is delivered in accordance with best practices.

**Requirements:**

  • Registered Nurse (RN) with current, valid, unrestricted license in the state of Texas.
  • 2 years of clinical practice experience in direct patient care.
  • 1 year of experience in condition management or case management in a health insurance, managed care, physician office, or hospital setting.
  • PC proficiency, including Word, Excel, OneNote, and database experience.
  • Clear and concise verbal and written communication skills.
  • Knowledge of utilization management, case management, and disease management activities and standardized criteria sets.
  • Familiarity with ancillary services, including home health care, skilled nursing facilities, and hospice care.

**Preferred Requirements:**

  • Experience in managing complex or catastrophic health cases.
  • Specialty clinical experience in neonatal intensive care unit (NICU), pediatric, obstetric, or labor and delivery settings.
  • Working towards or completion of Certified Case Manager (CCM), Certified Clinical Pharmacy Specialist (CCPS), or Certified Diabetes Educator (CDE) certification.
  • Knowledge of Milliman Guidelines or similar clinical guidelines.
  • Knowledge of medical management policies and procedures.

**What We Offer:**

  • A competitive salary and benefits package.
  • The opportunity to work with a purpose-driven company that values employee growth and development.
  • A collaborative and supportive work environment.


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