Health Management, Case Manager II

About the role

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team. Responsible for providing care management services and support to an assigned population with the purpose of improving health outcomes via a coordinated approach. The Care Manager II works in collaboration and continuous partnership with patients and their family members, as well as clinic, hospital, post-acute and insurance company partners, along with community resources, to achieve the desired outcomes. Using a defined process to identify patients/members at risk for poor outcomes, the Care Manager II establishes care plans and goals, and coordinates care and services throughout the continuum of care for patients assigned to the care management programs with the goal of enhancing patient health and well-being, improving adherence to health programs, and reducing health care costs. Must be highly collaborative with strong customer service skills and be able to demonstrate the ability to actively engage patients in positive relationships. Must also be able to demonstrate the knowledge and skills necessary to provide care management services appropriate to the patient/member being served.

Requirements

Education: Registered Nurse (RN) or Social Worker (LMSW). Licenses/Certifications: Registered Nurse (RN) or Licensed Master Social Worker (LMSW) or Licensed Clinical Social Worker (LCSW) with active license in the state of Texas.

Skills

• Experience in care/case management, chronic disease management or population health preferred.
• At least two (2) years of experience in care coordination and planning or other related area.
• Experience working in interdisciplinary teams.
• Excellent computer skills.
• Effective oral and written communication skills.

Responsibilities

• Provides primary care management interventions to identified members enrolled in the Health Management programs.
• In conjunction with payers and health care teams across the continuum, identify members at risk for poor outcomes, or experiencing poor coordination of services, who would benefit from more intensive follow-up and care coordination.
• Coordinates in conjunction with providers and health plans, a comprehensive plan of care for the high-risk, high-utilizing population, and collaborates with clinical staff and the patient/family in the development and execution of the plan of care, and achievement of goals.
• Provides proactive outreach to members to include telephonic, internet, or face-to-face encounters.
• Works cohesively with other health management disciplines to assist members in problem-solving potential issues related to financial and psychological barriers, as well as problems with the overall system of care.
• Increases continuity of care by managing and facilitating relationships with post-acute providers, physicians, and community resources.
• Manages effective transitions in care by facilitating warm hand-offs and closure of gaps in care.
• Promotes timely access to appropriate care and promote effective and efficient utilization of clinical resources.
• Promotes adherence to an established plan of care.
• Increases utilization of