Case Manager/ Registered Nurse

About the Role

At Houston Methodist Willowbrook Hospital, the Case Manager (CM) is a registered nurse (RN) responsible for comprehensively assessing clinical condition and planning for case management, including care transitions and discharge planning for a targeted patient population on designated unit(s) or service lines. The CM works with physicians and a multidisciplinary healthcare team to facilitate clinical care coordination, maintain compassionate, efficient, quality, and safe patient care, and achieve desired treatment outcomes. The CM holds joint accountability with the social worker for discharge planning, coordination of care, and throughput, ensuring admissions and continued stays are medically necessary. The role also communicates clinical information to payors and post‑acute care providers to ensure safe transition and continuity of care.

FLSA Status: Exempt

Qualifications

• Education: Graduate of an education program approved by the credentialing body for the required credential(s). Bachelor’s degree preferred.
• Experience: Minimum three years of hospital nursing clinical experience; acute care case management experience preferred.
• Licenses and Certifications: Required RN – Registered Nurse – Texas State Licensure (Texas Board of Nursing). Must obtain permanent Texas license within 60 days if establishing Texas residency (PSV Compact Licensure).

Knowledge and Abilities

• Demonstrates skills and competencies necessary to safely perform the assigned job, validated through ongoing assessments and performance evaluations.
• Proficient in speaking, reading, and writing English, especially for activities impacting patient or employee safety.
• Effective communication with patients, physicians, families, and co‑workers, applying a customer‑service focus and positive language principles.
• Knowledge of Medicare, Medicaid, and Managed Care requirements.
• Progressive knowledge of community resources, healthcare financial and payor requirements, and eligibility for state, local, and federal programs.
• Understanding of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement.
• Familiarity with pre‑acute and post‑acute venues of care and community resources.
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, patients, and families.
• Proficient with the Microsoft Office Suite (Excel, Outlook, PowerPoint, Word).
• Strong assessment, organizational, and problem‑solving skills.

Essential Functions

People

• Communicates actively, positively, and effectively with all healthcare team members, reporting pertinent clinical patient care and family data in an unbiased manner.
• Supports patients and families in preventing or resolving clinical or ethical issues.
• Collaborates with the multidisciplinary care team on discharge plans to improve outcomes and ensure safe transitions.
• Uses a structured format for regular communication with patients and families.
• Contributes to employee engagement improvement as reflected by department scores.

Service

• Assesses all patients timely and thoroughly per policy.
• Reviews charts for medical necessity, facilitates throughput, and appropriate utilization of inpatient resources.
• Initiates and facilitates referrals and transfers for home health care, hospice, durable medical equipment, and other post‑acute services.
• Participates in daily multidisciplinary rounds, presenting barriers to efficient patient throughput.
• Escalates discharge barriers to leadership or physician advisor as appropriate.
• Maintains ownership of the discharge planning process for assigned units.

Quality / Safety

• Modifies care based on continuous evaluation of the patient’s medical condition and progression.
• Demonstrates clinical problem‑solving and critical thinking within scope of practice, using evidence‑based analytical approaches.
• Documents accurate assessments and interventions efficiently.
• Educates patients and families on disease processes impacting health and readmission risk.
• Connects patients and families with relevant resources.
• Proactively plans routine discharges, elevates emergent situations, and escalates unresolved barriers.
• Manages patient assignments and unit demands, anticipating potential problems.
• Contributes to department and hospital targets for quality, patient satisfaction, and safety measures.

Finance

• Focuses on reducing length of stay and avoidable days across all levels of care by ensuring efficient, timely use of resources in discharge planning and transitions.
• Reviews medical records for medical necessity to facilitate timely discharge and reduce 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, prioritize tasks, and assist coworkers as needed.

Growth / Innovation

• Identifies areas for process improvement based on evidence‑based practice literature.
• Participates in evidence‑based practice and performance improvement projects, offering solutions.
• Seeks self‑development opportunities and takes appropriate action.
• Ensures career discussions occur with appropriate management.
• Maintains and updates the My Development Plan on an ongoing basis.

Supplemental Requirements

• Uniform: Business professional attire required; scrubs not required.
• On‑Call: May be required to be on‑call during emergencies (e.g., disaster, severe weather events).
• Travel: May require travel within the Houston Metropolitan area; travel outside the metropolitan area is not required.