RN Case Manager - ROI Search Group

We are seeking an RN Case Manager to join one of Houston’s largest Independent Physician Associations. This position is full-time and 100% on-site for the first three months. After that, the role transitions to a hybrid schedule with three days in the office (Monday through Wednesday) and two days working remotely (Thursday and Friday). Therefore, the RN Case Manager must live in the Houston area.

The RN Case Manager is responsible for overseeing and managing members experiencing complex or catastrophic illnesses, injuries, and/or specialty conditions such as diabetes, COPD, asthma, transplants, and more. The role ensures cost-effective and efficient utilization of health services while maintaining high-quality outcomes. Acting as a dedicated member advocate, the RN Case Manager seeks and coordinates innovative solutions to address members' healthcare needs without compromising the quality of care.

Resumes may be submitted directly or via email to hr@roisg.com.

Responsibilities:

• Obtain accurate member history and assess clinical information to develop personalized care plans, including support systems.
• Collaborate with members to establish short- and long-term goals tailored to their needs.
• Acquire and evaluate necessary health services, ensuring appropriate resource utilization and placement at the correct level of care.
• Document the effectiveness of case management services and maintain accurate, up-to-date records in compliance with federal, state, and health plan guidelines.
• Work collaboratively with internal teams, including Population Outreach and Care Management, to meet program goals and performance targets.
• Assist with pre- and annual delegation audits, analyze program data, and plan improvements.
• Review and audit care management plans to ensure data quality and alignment with member needs.
• Prepare care management reports, including outcomes and success metrics.
• Conduct crisis intervention and assist with discharge planning for hospitalized members.
• Apply nationally accepted criteria to determine appropriate levels of care and improve resource utilization practices.
• Maintain an active caseload and provide necessary interventions within the scope of expertise and credentials.
• Conduct patient and physician satisfaction surveys and address feedback for quality improvement.
• Participate in Quality Improvement processes, program-related meetings, and trainings.
• Communicate effectively with supervisors regarding complex issues and receive direction as needed.
• Exhibit proficiency in technical and critical thinking skills central to the nursing profession.
• Physical stamina to perform tasks involving sitting, standing, walking, reaching, and occasional crouching or kneeling.
• Mental stamina to work effectively under time-limited pressures and in stressful environments.
• Works with the Community Health Workers on non-medical issues.

Experience:

• Current, unrestricted Registered Nurse (RN) license in the State of Texas.
• Certified Case Manager (CCM) preferred.
• Strong knowledge of case management principles, procedures, and practices.
• Experience with Health Plans, Managed Care, and healthcare reimbursement systems.
• Bilingual in Vietnamese and/or Spanish is a plus.
• Familiarity with utilization management, discharge planning, and community resources.
• Proven ability to create programs, work independently, being a team player and multitask effectively in a high-volume environment.
• Proficient in computer skills, including case management (CM) software and office equipment (e.g., computer, printer, fax, copier).
• Ability to present ideas clearly and effectively in both written and verbal formats.
• Strong interpersonal skills with a proven track record of building and maintaining relationships.
• Clear, tactful communication via writing, reading, and telephone.

Benefits: 

This position offers a competitive benefits package which includes:

• Group benefits include medical, dental, vision, company paid $25k life with the option to add more voluntary life insurance coverage for employee and their family, STD, company paid LTD, 401k matching, and a variety of supplemental coverages such as hospital, cancer, legal, etc. available to the employee and their family.
• Employee funded FSA program.
• Paid Time Off ranging from 5-28 days depending on length of service.
• Profit Sharing Bonus Program
• 100% Employer Paid Pension Plan after 5 years
• Access to company gym and locker rooms in Houston offices

About ROI Search Group:

ROI Search Group is a woman-led staffing firm based in Fishers, IN. We provide comprehensive staffing solutions including direct hire, contract, and contract-to-hire in addition to other specialized and executive searches. Our unique methodology enables us to attract top talent and support candidates' career progression, aligning with our clients' and candidates' priorities to create mutual success.

At ROI Search Group, we are committed to fostering a workplace that values and celebrates diversity. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, or veteran status. We embrace the principles of equal employment opportunity and encourage all qualified candidates to explore career opportunities with us. We believe that a diverse and inclusive workforce enhances our creativity, innovation, and overall success. Join us in our commitment to equality and opportunity.