About this 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 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.