Case Manager

Job Description

The Case Manager position at Memorial Hermann supports the physician, primary medical homes, and interdisciplinary teams. They facilitate patient care, enhance clinical outcomes, and manage costs while providing timely and accurate information to payors.

• Facilitates patient care progression throughout the continuum.
• Works collaboratively with physicians, nursing, and other care team members to ensure timely, appropriate patient care.
• Addresses/resolves system problems impeding diagnostic or treatment progress.
• Proactively identifies and resolves delays and obstacles to discharge.
• Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load.
• Makes assignments for appropriate levels of care.
• Completes all required documentation in TQ screens and patient records.
• Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
• Applies approved clinical appropriateness criteria to monitor admissions and continued stays.
• Maintains a focus on continuous improvement in both LOS and ancillary resource use.
• Manages all aspects of discharge planning for assigned patients.
• Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients.
• Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.
• Maintains 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.
• Aids 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.
• Leads the development, implementation, evaluation, and revision of clinical pathways and other Case management tools as a member of the clinical resource/team.
• Aids in the compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators (e.g., readmission rates, unplanned return to OR, etc.).
• 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 preceptor, mentor, and resource to less experienced staff.
• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences.
• 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.
• Takes actions to achieve continuous improvement in both areas.
• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load.
• Makes assignments for appropriate levels of care.
• Completes all required documentation in TQ screens and patient records.
• Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
• Applies approved clinical appropriateness criteria to monitor admissions and continued stays.
• Maintains a focus on continuous improvement in both LOS and ancillary resource use.
• Manages all aspects of discharge planning for assigned patients.
• Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients.
• Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.
• Maintains 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.
• Aids 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.
• Leads the development, implementation, evaluation, and revision of clinical pathways and other Case management tools as a member of the clinical resource/team.
• Aids in the compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators (e.g., readmission rates, unplanned return to OR, etc.).
• 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 preceptor, mentor, and resource to less experienced staff.
• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences.
• Models Memorial Hermann's service standards by providing safe, caring, personalized, and efficient experiences to patients and colleagues.