RN Case Manager

This is a fully remote position, open to applicants in Texas.

📋 Description

• Perform telephonic evaluations for high-risk members

• Create personalized care plans and achievable health objectives

• Facilitate service coordination among providers, behavioral health teams, community resources, and members

• Inform members about chronic disease management, preventive care, medications, nutrition, and healthy lifestyle choices

• Assist in care transitions and help eliminate treatment barriers

• Keep precise documentation and ensure adherence to regulatory standards

• Act as an advocate for members, assisting them in navigating the healthcare system

• Enhance long-term health outcomes for Medicaid and underserved communities

⛳️ Requirements

• Active and unrestricted Texas RN license in good standing

• Must be a Texas resident

• Minimum of 3 years of experience in community health, public health, chronic disease management, community nursing, or case management

• At least 1 year of experience in care coordination and disease management/patient education

• Over 3 years of experience coordinating care with primary care providers

• Experience in outpatient case management within a health insurance, payer, or managed care setting

• Preferred experience in Medicaid Managed Care (STAR, CHIP)

• Preferred experience in Marketplace or Commercial Health Plans

• Knowledge of NCQA, HEDIS, HHSC, and TDI standards is preferred

• Preferred certifications such as CCM or other healthcare credentials

• Experience with Epic or other EHR systems is preferred

🏝️ Benefits

• Medical, dental & vision insurance

• Critical Illness, Accident, and Hospital coverage

• 401(k) Retirement Plan – Options for Pre-tax and Roth post-tax contributions

• Life Insurance (Voluntary Life & AD&D for the employee and dependents)

• Short and long-term disability insurance

• Health Spending Account (HSA)

• Transportation benefits

• Employee Assistance Program

• Time Off/Leave (PTO, Vacation, or Sick Leave)

• Support for work-life balance

• Collaborative team environment with significant growth potential