Nurse Case Manager

Job Description


Nurse Case Manager to assist members in understanding and utilizing health benefits, disease process and physician plan of care to achieve and maintain optimal health status.

• Assesses patient's health status & recommend appropriate care based on clinical judgment and protocols
• Adheres to ethical, legal/regulatory and accreditation standards
• Assesses consumer's understanding of their condition and identifies potential care and/or provider gaps
• Provides health education and coaches consumers on treatment alternatives to assist them in best decision making
• Assesses readiness to change, offering opportunities for intervention that will assist consumers in reaching their health care goals
• Supports consumers in selection of best physician and facility to maximize access, quality, and to manage heath care cost
• Empowers consumers with skills to enhance their interaction with their provider
• Coordinates services and referrals to health programs and community services
• Assesses and triages immediate health concerns
• Manages utilization through education
• Collaboratively plan care with member
• Document in and maintain legal medical records
• Communicate in writing the patient’s history, condition, plan of care and goals.

• Current, unrestricted RN licensure in the State of Texas; Bachelor's degree in Nursing (BSN) is required
• 2+ years of experience as a RN (Hospital, Clinical, Call Center, Physician's Office) working directly with customers/patients
• Ability to navigate a Windows based environment and create, edit, save and send documents utilizing Microsoft Word and Excel. Ability to navigate Outlook and conduct Internet searches.
• Proficiency with navigating multiple computer programs simultaneously while talking on the phone.
• Ability to understand readiness for change and ability to move members along the continuum of change
• Ability to work independently toward established priorities and goals
• Coaching, motivational interviewing and/or decision support experience
• Previous experience in a telephonic role is a plus
• Bilingual fluency with English and Spanish is a plus

Qualified applicants are considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.

Company Description
Top-rated Health Administration Company offers excellent opportunity to grow in a dynamic business. We are located in Katy, just off of Highway 99 and Westpark Tollway. We have been in business since 1970 and we are on the front lines of our industry. Because we are led by the best minds in the business, we are innovative, stable and we are growing.

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