Case Manager - Transition in Care

About the role

The Case Manager - Transition in Care position at Houston Methodist is responsible for facilitating safe and timely transitions of care for patients. This role requires a combination of clinical expertise and strong communication skills.

Responsibilities

• Communicates in an active, positive and effective manner to all healthcare team members and reports pertinent clinical patient care and family data in a comprehensive and unbiased manner.
• Collaborates with staff from the multidisciplinary care team concerning the discharge plan to improve outcomes and the safe transition of care.
• Communicates effectively with physicians, multidisciplinary care team, patients, and families to ensure safe and timely transitions of care.
• Contributes towards improvement of employee engagement as reflected by department scores, i.e., peer-to-peer accountability.

Qualifications

• Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section.
• Bachelor’s degree preferred.
• Three years hospital nursing clinical experience.
• Acute care case management experience preferred.

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).

Knowledge and Abilities

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations.
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security.
• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles.
• Knowledge of Medicare, Medicaid and Managed Care requirements.
• Progressive knowledge of community resources, healthcare financial and payor requirements/issues, and eligibility for state, local and federal programs.
• Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
• Understanding of pre-acute and post-acute venues of care and post-acute community resources.
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families.
• Well versed in computer skills of the entire Microsoft Office Suite (Excel, Outlook, PowerPoint and Word).
• Strong assessment, organizational and problem-solving skills.

Essential Functions

• People Essential Functions: Communicates in an active, positive and effective manner to all healthcare team members and reports pertinent clinical patient care and family data in a comprehensive and unbiased manner; listens and responds to the ideas of others. Supports patients and families in preventing/resolving clinical or ethical issues.
• Service Essential Functions: Assesses all patients timely, per policy, and thoroughly. Reviews chart for medical necessity and facilitation of throughput and appropriate utilization of inpatient resources and services, etc. Initiates and facilitates referrals and transfers for home health care, hospice, durable medical equipment, and other post-acute services.
• Quality/Safety Essential Functions: Modifies care based on continuous evaluation of the patient’s medical condition and progression. Demonstrates clinical problem-solving and critical thinking within the scope of practice and makes decisions using an evidence-based analytical approach. Documents accurate assessment and interventions efficiently and effectively.
• Finance Essential Functions: Focuses on reducing length of stay for all levels of care, (inpatient, observation and outpatient in a bed) and avoidable days by ensuring efficient and timely use of resources in discharge planning and transitions. Reviews medical records for medical necessity for continued stay, facilitate timely discharge to reduce discharge delays.
• Growth/Innovation Essential Functions: Identifies areas for process improvement based on understanding of evidence-based practice literature. Participates in evidence-based practice/performance improvement projects based on these observations and offers solutions.

Supplemental Requirements

• Work Attire: Uniform: No, Scrubs: No, Business professional: Yes, Other (department approved): No.
• On Call*: Yes.
• May require travel within the Houston Metropolitan area: Yes.
• May require travel outside Houston Metropolitan area: No.

Company Profile

Houston Methodist is one of the nation’s leading health systems and academic medical centers. The health system consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the Texas Medical Center, seven community hospitals and one long-term acute care hospital throughout the Greater Houston metropolitan area. Houston Methodist also includes a research institute; a comprehensive residency program; international patient services; freestanding comprehensive care clinics, emergency care and imaging centers; and outpatient facilities. Come lead with us!

Houston Methodist is an Equal Opportunity Employer.