Case Manager- Population Health

Job Title

Case Manager

Houston, TX

We are searching for a Case Manager who will utilize a collaborative approach. The nurse case manager will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual's health needs. This role provides comprehensive ongoing case management services to Texas Children’s Health Plan members, coordinating and managing care of high‑risk members to meet multiple service needs across the continuum of care, ensuring optimal member outcomes that address quality, service, customer satisfaction, and cost effectiveness.

The case manager also assists members and their families in coping with illness by optimizing self‑care abilities and supporting consumer rights.

• 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 obtaining and maintaining an RN license.
• RN – Licensed Registered Nurse (Texas Board of Nursing or Nursing Licensure Compact) required.
• Case Management Certification preferred.
• Minimum 3 years of clinical experience in pediatrics, including home care, case management, managed care, or utilization review.

• Assess, develop, implement, and monitor a comprehensive plan of care through an interdisciplinary team process in conjunction with the member/family.
• Proactively identify members in need of case management through clinical rounds, referrals, and consultation with primary HMO staff, medical director, PCP, parents, TCH staff, and other internal TCHP areas.
• Comprehensively assess members’ biophysical, psychosocial, environmental, discharge planning, and financial needs.
• Participant in planning and coordinating services across the continuum of care and document this plan in the designated system.
• Ensure continuity of care and serve as advocate on behalf of members and families across the continuum of care.
• Identify problems, barriers, and opportunities for intervention; provide resolution and revise plans on an ongoing basis.
• Routinely assess member status and progress, and if progress is static or regressive determine the reason and proactively encourage appropriate adjustments in the care plan, providers, and services to promote better outcomes.

Founded in 1996, Texas Children’s Health Plan is the nation’s first health maintenance organization created just for children. We provide STAR/Medicaid and CHIP to pregnant women, teens, children, and adults in Houston and surrounding areas. Our network includes more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals, serving over 375,000 members.

Texas Children’s 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, or local status unrelated to the performance of the work involved.