Care Manager - RN (Bilingual Spanish Preferred)

Location: 19500 HWY 249, Suite 570, Houston, TX 77070

About the role

We are looking for a compassionate and experienced Care Manager - RN to join our Houston team. In this role, you will provide comprehensive care management and coordination for members across the continuum of care, partnering with providers, interdisciplinary teams, and community resources to improve clinical outcomes, enhance quality of care, and support members with complex medical, behavioral, and psychosocial needs.

Our Values

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

Responsibilities

Care Management & Coordination

• 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.

Clinical Oversight

• 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.

Utilization Management & Cost Containment

• 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.

Collaboration & Communication

• 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.

Quality & Compliance

• 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.

Requirements

• 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)
• Active, unrestricted Registered Nurse (RN) license
• Strong clinical background with experience in 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

Preferred Qualifications

• Bilingual proficiency in Spanish/English strongly preferred
• Able to work independently and make independent decisions
• Ability to 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

Schedule

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 occasional travel for onsite visits or team meetings.

Pay

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.