Case Manager

About the role

At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN) responsible for comprehensively assessing clinical condition and planning for case management, which includes care transitions and discharge planning of a targeted patient population on a designated unit(s) and/or service lines. This position works with the physicians and multidisciplinary healthcare team to facilitate clinical care coordination and maintain compassionate, efficient, quality and safe patient care and achievement of desired treatment outcomes.

Responsibilities

• Works with the physicians and multidisciplinary healthcare team to facilitate clinical care coordination and maintain compassionate, efficient, quality and safe patient care and achievement of desired treatment outcomes.
• Communicates clinical information to payors and post-acute care providers to ensure safe transition and continuity of care.
• Assesses all patients timely, per policy, and thoroughly.
• Reviews chart for medical necessity and facilitation of throughput and appropriate utilization of inpatient resources and services, etc.
• Initiates and facilitates referrals and transfers for home health care, hospice, durable medical equipment, and other post-acute services.
• Participates and is prepared to present barriers to efficient patient throughput in daily multi-disciplinary rounds (MDRs).
• Escalates appropriate discharge barriers to leadership and/or physician advisor.
• Facilitates discharge planning activities for assigned patients and collaborates with other members of the multidisciplinary care team, as well as patient and family, on clinically complex care transitions and discharges.
• Maintains ownership of the discharge planning process on assigned units.
• Focuses on discharge domain by contributing to department and hospital targets for quality, patient satisfaction and safety measures.
• Focuses on reducing length of stay for all levels of care, (inpatient, observation and outpatient in a bed) and avoidable days by ensuring efficient and timely use of resources in discharge planning and transitions.
• Reviews medical records for medical necessity for continued stay, facilitate timely discharge to reduce discharge delays.
• Applies knowledge of payor requirements and coverage to facilitate cost-effective discharges.
• Contributes to meeting department and hospital financial targets.
• Utilizes resources with cost effectiveness and value creation in mind.
• Self-motivated to independently manage time effectively and prioritize daily tasks, assisting coworkers as needed.
• Identifies areas for process improvement based on understanding of evidence-based practice literature.
• Participates in evidence-based practice/performance improvement projects based on these observations and offers solutions.
• Sets and achieves personal development goals.

Qualifications

• Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section.
• Bachelor’s degree preferred.
• Three years hospital nursing clinical experience.
• Acute care case management experience preferred.

Skills

• Active, positive and effective communication.
• Effective listening and response to the ideas of others.
• Collaboration with staff from the multidisciplinary care team.
• Structured communication with patients, families, and co-workers.
• Independent and sound judgment in interactions with physicians, payors, and patients and their families.
• Proficiency in speaking, reading, and writing the English language.
• Knowledge of Medicare, Medicaid and Managed Care requirements.
• Progressive knowledge of community resources, healthcare financial and payor requirements/issues, and eligibility for state, local and federal programs.
• Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
• Understanding of pre-acute and post-acute venues of care and post-acute community resources.
• Strong assessment, organizational and problem-solving skills.

Benefits

Commensurate with experience.

Pay

TBD

Schedule

TBD

Supplemental Requirements

• Uniform: No Scrubs: No Business professional: Yes Other (department approved): No
• On-call: Yes
• Travel: May require travel within the Houston Metropolitan area Yes May require travel outside Houston Metropolitan area No

Equal Opportunity Employer

Houston Methodist is an Equal Opportunity Employer.