Lead RN Case Manager

RN Case Manager

Nexus Children's Hospital Shenandoah specializes in providing comprehensive, pediatric-focused care for children and adolescents with complex medical, neurological, and rehabilitative needs. Our interdisciplinary approach supports recovery, independence, and long-term quality of life through coordinated medical care, therapy services, and family engagement. We are committed to empowering patients and families throughout their healthcare journey with compassion, expertise, and a collaborative spirit.

Position Summary

The RN Case Manager is responsible for assessing patient and family psychosocial needs, planning and coordinating care, and evaluating clinical progress across the healthcare episode. This role ensures cost-effective care delivery within appropriate length of stay while preventing fragmentation of services. Working collaboratively with physicians, payors, and an interdisciplinary healthcare team, the RN Case Manager supports age-specific and patient-focused outcomes, linking resource management with quality care.

Job Responsibilities

General Responsibilities

• Maintains PHI and HIPAA compliance according to hospital policy and federal regulations.
• Promotes a safe working environment and safe patient care at all times.
• Practices "minimum information necessary" when performing utilization review, case management, and discharge functions.
• Acts as a patient advocate for all patients within the facility.
• Adheres to all regulatory, company, and ethical standards of practice.
• Demonstrates respect, professionalism, and confidentiality at all times.
• Supports and models the organization's mission, vision, and values.

Case Management & Coordination

• Conducts initial and ongoing patient assessments, focusing on clinical needs, discharge criteria, and family support.
• Plans, coordinates, and facilitates interdisciplinary care conferences.
• Evaluates ongoing treatment plans and collaborates with providers for necessary adjustments.
• Prevents service duplication and ensures appropriate use of resources.
• Collaborates with third-party payors to provide medical information and support authorization processes.
• Coordinates discharge planning, ensuring safe and effective transition to the next level of care.

Patient & Family Engagement

• Serves as a primary communication point for patient families and outside agencies.
• Provides education regarding treatment goals, discharge needs, and community resources.
• Facilitates problem-solving and addresses barriers to discharge or care progression.

Qualifications

• Current RN license in the State of Texas (required)
• Bachelor of Science in Nursing preferred
• Case Management certification (ACM or CCM) preferred
• Prior experience in pediatrics, rehabilitation, acute care, behavioral health, or complex medical case management strongly preferred
• Strong communication skills and ability to work effectively with families under stress
• Experience with utilization review or managed care interaction is a plus

Why Join Nexus?

• Mission-driven pediatric and neuro-rehabilitation environment
• Collaborative and supportive interdisciplinary culture
• Opportunity to impact children and families facing complex healthcare challenges
• Competitive compensation & benefit package