Local Contract Nurse RN - Clinic Case Manager, Utilization Review
Dallas, TX
Apidel Technologies
5x8 hrs, Days
Referral Bonus

***This is a Local Contract job in Dallas, TX ***** No Travel worker will be considered.

Note: Candidates MUST be Dallas or Tarrant County. This is a FIELD and Telephonic role; 85% travel

Job Description
Position: Nurse Case Manager
Location: Dallas and Tarrant County Hybrid
Duration: 6+ Months (with possibilities of extension)
Shift: 8AM TO 5PM

This is a FIELD and Telephonic role; 85% travel. Candidates will be required to have a dedicated home office free of distractions and complies with HIPPAA requirements

Position Summary
The Referral Nurse serves as a key clinical resource within the STAR Kids Medicaid managed care program, providing comprehensive in-person assessments for children and youth (ages 0–20) with disabilities or complex medical needs. This role applies a collaborative process of assessment, planning, facilitation, and advocacy to coordinate services that align with the member’s benefit plan and health needs, promoting optimal, cost-effective outcomes through effective communication and resource utilization.

Key Responsibilities
• Conduct comprehensive in-person assessments using clinical tools and data review to determine member needs, eligibility, and appropriate interventions.
• Develop and implement Individual Service Plans (ISP) in collaboration with members, families, and interdisciplinary teams.
• Coordinate Medicaid benefits, long-term services and supports (LTSS), and community resources to meet member needs.
• Apply and interpret clinical criteria, guidelines, and regulatory standards to ensure accurate administration of benefits.
• Facilitate transitions of care and ensure continuity of services across settings.
• Document all assessments, care plans, and communications in compliance with HHSC STAR Kids contract requirements and company policies.
• Collaborate with service coordinators, providers, and external agencies to resolve barriers to care.

Requirements
• Active, unrestricted RN license in Texas.
• Minimum 2 years of clinical experience in pediatrics, case management, or home health Required.
• Strong knowledge of Medicaid benefits, STAR Kids program requirements, and regulatory standards.
• Excellent communication, organizational, and problem-solving skills.
• Ability to work independently in the field and manage multiple priorities.

Experience
• Experience with Medically Dependent Children Program (MDCP) or other waiver programs.