Job Description

Benefits

• Paid Time Off & Paid Company Holidays
• Medical, Dental, Vision & Life Insurance
• Flexible Spending Account (FSA)
• 403(b) Retirement Plan with Company Match
• Short-Term & Long-Term Disability
• $0 Copay for Legacy Provider visits
• $0 Copay for prescriptions filled at Legacy Pharmacies
• Travel Insurance & Pet Insurance
• Subsidized Gym Membership
• And much more!

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Location: Legacy Montrose Allen Parkway - 2929 Allen Pkwy. Houston, TX 77019

Registered Nurse - Care Manager (Job Overview)

Schedule: Monday-Friday (8AM-5PM)

Are you ready to make a meaningful impact on the lives of patients in our community? At Legacy Community Health, we’re more than just a healthcare provider—we’re a family committed to delivering holistic care that addresses both health and social needs. As an Registered Nurse - Care Manager, you’ll play a pivotal role in guiding high-risk, chronic illness, and emerging high-risk patients toward healthier, more fulfilling lives. Your expertise and compassion will be the cornerstone of our mission-driven care model.

Why You'll Love This Role:

• Be at the heart of a collaborative, multidisciplinary care team dedicated to transforming lives.
• Build lasting, meaningful relationships with patients, empowering them to take charge of their health journeys.
• Enjoy a supportive and dynamic work environment that values your voice and encourages innovation.
• Make a real difference by reducing avoidable ER visits, hospital admissions, and readmissions.
• Access abundant opportunities for professional growth, mentorship, and personal development.

Key Responsibilities

• Collaborate with multidisciplinary team members to address the unmet needs of assigned patient populations.
• Conduct telephonic outreach and home/virtual visits based on patient acuity and care requirements.
• Perform comprehensive health risk and disease management assessments, including psycho-social care needs.
• Deliver outreach, education, and interventions to patients with high utilization patterns to prevent avoidable hospital admissions.
• Develop patient-centered care plans in partnership with patients and the care team.
• Coordinate services with primary care teams, specialists, home care providers, hospital teams, and managed care organizations.
• Monitor patient progression toward goals and adjust care plans as needed to ensure success.
• Identify and address barriers to meeting goals, adhering to treatment plans, or keeping appointments.
• Build collaborative relationships with patients to promote disease prevention and health self-management.
• Participate in caseload rounds and consultations with the care team to ensure optimal care delivery.
• Assist patients in obtaining medical supplies and referrals for additional education or services.
• Maintain accurate and timely medical documentation of care management activities in the designated care management module.
• Adhere to assigned caseloads, timeframes, and Legacy Community Health safety reporting guidelines.
• Contribute to refining and developing new standards of work to enhance care quality.
• Manage caseloads effectively to reduce avoidable ER visits, hospital admissions, and readmissions.
• Attend staff meetings and participate in ongoing educational opportunities to enhance your skills.
• Perform other duties as assigned to support the overall mission of Legacy Community Health.

Minimum Qualifications

• Registered Nurse with an active, unrestricted Texas licensure
• Must maintain BLS/CPR
• State Board recognized nursing education
• 3-5 years acute clinical experience
• 1-2 years case/care management experience
• Case Management Certification
• Motivational interviewing
• Experience with all patient populations, including, Commercial, Medicaid & Medicare
• Computer literacy: Ability to operate computer programs and work within various documentation platforms
• Strong customer service skills to coordinate service delivery including proactive identification and resolution of issues that will promote positive patient outcomes
• This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management
• Federally Qualified Health Clinic (FQHC) experience
• Bilingual (Spanish)
• Ability to think critically and problem solve

About Legacy Community Health

As the largest Federally Qualified Health Center (FQHC) in Southeast Texas, Legacy Community Health has been delivering comprehensive, high-quality, and affordable health care for nearly 40 years. With more than 50 clinics across the Greater Houston and Gulf Coast region, we continue to grow strategically and invest in our communities. By innovating how care is delivered, we've stayed at the forefront of connecting our communities to health—every day, in every way. At Legacy, we know our success is powered by our people. We're always looking for talented, passionate individuals who want more than a job—they want a meaningful career that makes a real impact. Explore our open positions and see if a career at Legacy is right for you.

At Legacy Community Health, our mission—Driving healthy change in our communities—guides everything we do. To fulfill this mission, every team member is expected to embody the following core attributes in their daily work, regardless of role or department:

Approachable & Collaborative

We bring our expertise without ego. In a collaborative healthcare environment, humility fosters trust and teamwork. Our employees value diverse perspectives, seek input from others, and are unafraid to acknowledge when they need help. We stay grounded in our purpose: to serve patients and communities with compassion and humility.

Driven & Committed

We are driven by a deep commitment to excellence in patient care and organizational improvement. Our employees take initiative, embrace challenges, and go the extra mile to support our mission. Whether improving patient outcomes, streamlining processes, or stepping up in times of need, we are always striving to drive healthy change—within ourselves, our teams, and the communities we serve.

Perceptive & Thoughtful Communicators

We value emotional intelligence as much as clinical or technical skill. Our team members demonstrate sound judgment, cultural sensitivity, and the ability to navigate complex situations with empathy and professionalism. They communicate clearly and respectfully with patients, families, and colleagues, building trust and fostering a safe, inclusive environment for all.