Case Manager

About the role

The Case Manager position at Memorial Hermann supports the physician, primary medical homes, and interdisciplinary teams. The role facilitates patient care, enhances clinical outcomes and patient satisfaction, manages cost of care, and provides timely and accurate information to payors.

Responsibilities

• Supports diagnostic and treatment progress by addressing/resolving system problems and seeking consultation as required.
• Facilitates timely completion of diagnostic testing, treatment plan, and discharge plan.
• Communicates with third-party payors and updates care team with relevant information.
• Assigns appropriate levels of care and completes required documentation.
• Monitors LOS and ancillary resource use, taking actions to improve efficiency.
• Collaborates with the Care Management Medical Director and Resource Center to resolve payor issues and ensure covered day reimbursement.
• Ensures continuity of care by communicating with patient/family and healthcare team.
• Develops and implements discharge plans, including individualized continuing care plans.
• Facilitates referrals for home health care, hospice, medical equipment and supplies.
• Collects and analyzes data to drive performance improvement strategies.
• Assists in the development and implementation of clinical pathways and tools.
• Supports the collection and reporting of financial indicators and physician profile data.
• Prepares for and participates in clinical performance improvement activities.
• Promotes safe care, adheres to policies, and supports departmental goals.
• Maintains professional growth and development by meeting educational and competency requirements.

Requirements

Minimum qualifications include a graduate of an accredited school of professional nursing or a graduate of an accredited Masters of Social Work program, with a current and valid license to practice as a Registered Nurse in Texas or a Master Social Worker (LMSW) license in Texas, with LCSW preferred. Certification in Case Management is required within two years of hire.

• Three (3) years of nursing or social work experience in an acute hospital-based setting, or three (3) years of comparable clinical experience.
• Experience in utilization management, case management, discharge planning, or other cost/quality management programs.
• Excellent interpersonal communication and negotiation skills.
• Demonstrated leadership skills.
• Strong analytical, data management, and PC skills.
• Understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre and post acute care.
• Understanding of motivational interviewing and change management.
• Strong organizational and time management skills.
• Ability to work independently and exercise sound judgment.
• Effective oral and written communication skills.

Qualifications

• Education: Graduate of an accredited school of professional nursing or graduate of an accredited Masters of Social Work program.
• Licenses/Certifications: Current and valid license to practice as a Registered Nurse in Texas or a Master Social Worker (LMSW) license in Texas, LCSW preferred; Certification in Case Management required within two years of hire.
• Experience: Three (3) years of nursing or social work experience in an acute hospital-based setting, or three (3) years of comparable clinical experience.
• Knowledge/Skills: Experience in utilization management, case management, discharge planning, or other cost/quality management programs; excellent interpersonal communication and negotiation skills; strong analytical, data management, and PC skills; understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre and post acute care; understanding of motivational interviewing and change management; strong organizational and time management skills; ability to work independently and exercise sound judgment; effective oral and written communication skills.