RN Case Manager

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

📋 Description

• Perform telephonic evaluations for high-risk individuals.

• Create tailored care plans and set measurable health objectives.

• Facilitate coordination of services among providers, behavioral health teams, community resources, and members.

• Provide education to members regarding chronic disease management, preventive healthcare, medications, nutrition, and healthy lifestyle choices.

• Assist with transitions of care and eliminate obstacles to treatment.

• Keep thorough documentation and ensure compliance with regulations.

• Advocate for members and assist 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 resident of Texas.

• 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 with Medicaid Managed Care (STAR, CHIP).

• Preferred: Experience with Marketplace or Commercial Health Plans.

• Familiarity with NCQA, HEDIS, HHSC, and TDI standards.

• Preferred: CCM or other healthcare certifications.

• Preferred: Experience with Epic or other EHR systems.

• Availability for a Monday-Friday, 8 AM-5 PM schedule.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Critical Illness, Accident, and Hospital insurance.

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

• Life Insurance (Voluntary Life & AD&D for both employees and dependents).

• Short-term and long-term disability coverage.

• Health Spending Account (HSA).

• Transportation benefits.

• Employee Assistance Program.

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

• Work-life balance.

• Collaborative team environment with significant growth opportunities.

• Exposure to population health and managed care initiatives.