Case Manager (Nex)

Cook Children's Health Care System
United States, Texas, Prosper
Apr 11, 2025
Location: Medical Center-Prosper Department: Case Management Shift: First Shift (United States of America) Standard Weekly Hours: 4 Summary: The RN Case Manager uses a collaborative process to plan, assess, implement, monitor and evaluate the options and services required to meet the healthcare needs of patients using the functions of Utilization Review using InterQual and Milliman Care Guidelines, Discharge Planning and Case Management in order to facilitate: (1) quality of patient care; (2) cost effective utilization and outcome management; (3) communication between patients, families, and members of the health care team; (4) expedition of the movement of patients through appropriate levels of care; and (5) information gathering for Quality & Risk Management utilizing Joint Commission Accreditation of Healthcare standards and clinical indicators. The RN Case Manager will assist with the identification of appropriate providers and facilities throughout the continuum of care, to ensure that resources of both Cook Childrens Medical Center Prosper (CCMCP) and the patient are used in a timely and cost-effective manner to meet the healthcare needs of the patient. Education: BSN preferred. Current Texas RN license required At least three years of clinical experience required Three years of experience in case management/utilization review preferred Discharge planning preferred and bilingual desirable Experience in quality assurance, clinical pathways and continuous quality improvement is highly desirable Computer literate Effective organizational skills, interpersonal skills, written and oral communication skillsare critical Ability to adapt to changing healthcare environment; ability to work with all members of the healthcare team to achieve positive outcomes Certification/Licensure: Current Texas RN license Basis Life Support (BLS) certification for Health Care Providers required within 30 days of employment and must be maintained per Medical Center Policy, MC 175. About Us: Cook Children's is an equal opportunity employer. As such, Cook Children's offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.