Case Manager

Job Description

The Case Manager position supports the physician, primary medical homes, and interdisciplinary teams. They facilitate patient care, enhance clinical outcomes and patient satisfaction, and manage the cost of care. The role integrates and coordinates resource utilization management, care facilitation, and discharge planning functions. The Case Manager also helps drive performance improvement initiatives.

• Facilitates patient care progression throughout the continuum.
• Works collaboratively with physicians, nursing, and other members of the multi-disciplinary care team to effect timely, appropriate patient care.
• Addresses/resolves system problems impeding diagnostic or treatment progress.
• Proactively identifies and resolves delays and obstacles to discharge.
• Serves as a resource for consulting with appropriate disciplines/departments to expedite care and facilitate discharge.
• Coordinates and facilitates care for a designated patient caseload.
• Maintains and updates the plan of care to meet the ongoing needs of the patient.
• Communicates to third party payors and other relevant information to the care team.
• Assigns appropriate levels of care.
• Completes Utilization Management and Quality Screening for assigned patients.
• Monitors LOS and ancillary resource use on an ongoing basis.
• Manages discharge planning for assigned patients.
• Collaborates with the multidisciplinary team in all phases of discharge planning process.
• Ensures plan consensus from patient/family, physician, and payor.
• Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment and supplies.
• Documents relevant discharge planning information in the medical record according to Department standards.
• Facilitates transfer to other facilities as appropriate.
• Participates in clinical performance improvement activities.
• Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.
• Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients.
• Collects, analyzes, and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team.
• Learns and assists in the development of clinical pathways and other Case management tools as a member of the clinical resource/team.
• Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators.
• Acts as a preceptor/mentor to new hires.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
• Serves as a resource to less experienced staff.
• Adheres to Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Models Memorial Hermann's service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

Principal Accountabilities

• Coordinates/facilitates patient care progression throughout the continuum.
• Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient care.
• Addresses/resolves system problems impeding diagnostic or treatment progress.
• Proactively identifies and resolves delays and obstacles to discharge.
• Serves as a resource for consulting with appropriate disciplines/departments to expedite care and facilitate discharge.
• Coordinates and facilitates care for a designated patient caseload.
• Maintains and updates the plan of care to meet the ongoing needs of the patient.
• Communicates to third party payors and other relevant information to the care team.
• Assigns appropriate levels of care.
• Completes Utilization Management and Quality Screening for assigned patients.
• Monitors LOS and ancillary resource use on an ongoing basis.
• Manages discharge planning for assigned patients.
• Collaborates with the multidisciplinary team in all phases of discharge planning process.
• Ensures plan consensus from patient/family, physician, and payor.
• Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment and supplies.
• Documents relevant discharge planning information in the medical record according to Department standards.
• Facilitates transfer to other facilities as appropriate.
• Participates in clinical performance improvement activities.
• Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.
• Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients.
• Collects, analyzes, and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team.
• Learns and assists in the development of clinical pathways and other Case management tools as a member of the clinical resource/team.
• Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators.
• Acts as a preceptor/mentor to new hires.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
• Serves as a resource to less experienced staff.
• Adheres to Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Models Memorial Hermann's service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.