Case Manager RN RGV

About the role

The Case Manager is responsible for evaluating, coordinating, and implementing the functions of Utilization Review and Discharge Planning to coordinate quality patient care, cost-effective outcome management, and communication between patients, families, and the healthcare team.

Responsibilities

• Maintains utmost level of confidentiality at all times
• Adheres to hospital policies and procedures
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines
• Identifies patients who need discharge planning services and high-risk or potential problematic cases
• Develops and reviews each stage of care, analyzes patterns of variance, and implements strategies to resolve them
• Documents resource management activities separately from the medical record
• Involves patient caregivers in the plan of care and assesses patient/family needs thoroughly
• Reassesses patient/family needs as needed and participates in regular peer discussions and collaboration regarding caseload management
• Collaborates closely with Social Workers to ensure effective communication and planning for patient needs
• Participates in quality improvement activities to improve the delivery of high-quality, cost-effective patient care
• Maintains professional standards through licensure, certification, education, and development
• Consults with hospital staff and physicians regarding patient continuity of care needs and identifies best practice patterns based on comparative data
• Documents discharge planning activities in the medical record and collaborates with providers, members of the healthcare team, payers, patients, and family members to coordinate care

Qualifications

Bachelor's degree from a four-year college or university, or one to two years of related experience and/or training, or an equivalent combination of education and experience. Associate’s degree with five years of related experience required.

Skills

• Bilingual skills in Spanish preferred

Certificates, Licenses, Registrations

• Registered and currently licensed by the Board of Nurse Examiners for the State of Texas
• Current CPR certification
• National certification in the applicable area to be obtained within 2 years of eligibility