Case Manager (RN) - PRN

About the role

The Case Manager PRN (CM) position at Houston Methodist The Woodlands Hospital is a licensed registered nurse (RN) who plans comprehensive case management for a targeted patient population on designated units. This role works closely with physicians and the interprofessional health care team to ensure efficient and high-quality care, while also facilitating discharge planning and ensuring clinical information is communicated to payors for reimbursement.

Responsibilities

• Collaborates with the physician and interprofessional health care team to facilitate patient care
• Maintains the patient's progress, intervening as needed to ensure the plan of care and services provided are patient-focused, efficient, and cost-effective
• Facilitates timely completion and reporting of diagnostic testing, treatment plan, and discharge plan
• Assigns appropriate levels of care and ensures all required documentation in EPIC and MIDAS is completed
• Serves as a preceptor and implements staff education specific to patient populations and unit processes
• Serves as a resource for case management and social work resources and needs for the department and the hospital
• Reviews medical necessity of admission, continued stay, and resource use, and applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay
• Monitors Length of Stay (LOS) for case load on an ongoing basis, identifies trends, and contributes to meeting departmental financial targets
• Manages all patients in Observation Status, informs physicians of timely disposition options, and secures reimbursement for hospital services
• Provides education to unit-based physicians, nurses, and other healthcare providers on case management topics and offers innovative solutions through evidence-based practice/performance improvement projects

Requirements

• Graduate of an education program approved by the credentialing body for the required credential(s)
• Three (3) years hospital clinical nursing experience, including two (2) years in case management
• Required RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)

Skills and Abilities

• Demonstrates skills and competencies necessary to safely perform the assigned job
• Effective communication with patients, physicians, family members, and co-workers
• Strong assessment, organizational, and problem-solving skills
• Comprehensive knowledge of community resources, health care financial and payer requirements/issues, and eligibility for state, local, and federal programs
• Knowledge of Medicare, Medicaid, and Managed Care requirements
• Understanding of pre-acute and post-acute venues of care and post-acute community resources
• Independent decision-making and critical thinking using evidence-based analytical approach
• Well versed in computer skills of the entire Microsoft Office Suite

Qualifications

• Education: Graduate of an education program approved by the credentialing body for the required credential(s)
• Experience: Three (3) years hospital clinical nursing experience, including two (2) years in case management
• Licenses and Certifications: Required RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)