Care Manager - RN (Bilingual Spanish Preferred)

Description

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Conduct comprehensive health assessments, including medical, behavioral, and social determinants of health (SDOH). 
• Develop, implement, and evaluate individualized care plans based on member needs, goals, and risk level. 
• Coordinate care across multiple settings, including inpatient, outpatient, and community-based services. 
• Facilitate transitions of care, including hospital discharge planning and post-discharge follow-up. 

• Utilize clinical expertise to identify gaps in care, potential risks, and opportunities for early intervention. 
• Monitor member progress and adjust care plans accordingly. 
• Provide education to members and caregivers regarding disease management, medications, and treatment plans. 
• Apply evidence-based guidelines and best practices in care management. 

• Support appropriate utilization of healthcare services to ensure cost-effective care delivery.
• Collaborate with utilization management teams to reduce avoidable hospitalizations and emergency department visits. 
• Identify high-risk members and implement strategies to improve outcomes and reduce healthcare costs. 

• Partner with physicians, specialists, behavioral health providers, and community agencies to coordinate care. 
• Serve as a liaison between members, providers, and health plan resources. Participate in interdisciplinary team meetings and case conferences. Maintain effective communication to ensure continuity of care. 

• Ensure timely and accurate documentation in accordance with regulatory, CMS, and organizational requirements. 
• Support quality improvement initiatives, including HEDIS, STAR ratings, and other performance measures. 
• Maintain compliance with accreditation standards and internal policies. 
• Member Engagement Conduct outreach to engage members in care management programs.
• Promote self-management and adherence to treatment plans. 
• Address barriers to care, including social, economic, and cultural factors. 

Qualifications

• Bachelor of Science in Nursing (BSN) preferred; Associate degree in Nursing required
• Texas RN unrestricted active license
• At least 2 years of clinical nursing experience (case management, acute care, medical group, health plan, or managed care preferred)
• Certifications & Licensure Active, unrestricted Registered Nurse (RN) license
• Strong clinical background must be familiar with developing care plans and assessments
• Experience with Microsoft Office Word
• Understanding of regulatory standards (CMS, NCQA, etc.). 
• Ability to assess and manage complex clinical and psychosocial situations
• Excellent communication, collaboration, and critical-thinking skills
• Proficiency in electronic health records (EHR) and care management documentation systems
• Ability to manage multiple priorities in a fast-paced environment

• Bilingual proficiency in Spanish/English strongly preferred
• Able to work independently and make independent decisions
• Ability to work prioritize and multi-task
• Excellent written and verbal communication skills
• Maintain courteous professional attitude when working with internal and external customers
• Maintains member confidence and protects operations by keeping claim information confidential in compliance with HIPAA requirements

Environmental Job Requirements and Working Conditions

• This role follows a hybrid work structure where the expectation is to work on the field and at home on a weekly basis. The office is located at 19500 HWY 249, Suite 570 Houston, TX 77070.
• This position requires up occasional travel for onsite visits or team meetings.
• The target pay range for this role is between $80,000 - $94,000 annually. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.