Supp Case Mgr

About the Role

The Case Manager supports physicians, primary medical homes, and interdisciplinary teams in facilitating patient care to enhance clinical outcomes and patient satisfaction while managing costs. This role integrates resource utilization management, care facilitation, and discharge planning, and drives performance improvements in workflows, education, and processes. The Case Manager coordinates self-management support, maintains disease registry activity, and manages a designated patient caseload to meet needs across the care continuum.

Responsibilities

• Coordinates and facilitates patient care progression throughout the continuum.
• Collaborates with physicians, nursing, and multidisciplinary teams to ensure timely, appropriate patient care and resolves system issues impeding progress.
• Proactively identifies and resolves delays and obstacles to discharge, seeking consultation as needed.
• Monitors patient progress, intervening to ensure the plan of care is patient-focused, high-quality, efficient, and cost-effective.
• Facilitates diagnostic testing, treatment plans, discharge plans, and modifications to care plans.
• Communicates with third-party payors and ensures appropriate levels of care are assigned.
• Documents key clinical path variances and outcomes, using pathway data for effective patient management.
• Leads the development, implementation, and evaluation of clinical pathways and case management tools.
• Assists in compiling physician profile data on length of stay (LOS), resource utilization, denied days, costs, and quality indicators.
• Acts as a preceptor/mentor to new hires and assists in orientation development.
• Completes Utilization Management and Quality Screening for assigned patients, applying clinical appropriateness criteria.
• Identifies at-risk populations and monitors LOS and ancillary resource use for continuous improvement.
• Refers cases to the Care Management Medical Director and communicates with the Resource Center for reimbursement certification.
• Manages all aspects of discharge planning, including assessing patient/family needs and developing individualized care plans.
• Collaborates with external case managers and facilitates referrals for home health care, hospice, and medical equipment.
• Documents discharge planning information in medical records and facilitates transfers to other facilities.
• Participates in clinical performance improvement activities, collecting and reporting financial and clinical indicators.
• Analyzes variances from care plans and uses data to drive practice changes and improve outcomes.
• Ensures safe, compassionate, and personalized care for patients, adhering to organizational policies and standards.
• Promotes professional growth through continuing education and mentorship.

Requirements

• Graduate of an accredited school of professional nursing or graduate of an accredited Master of Social Work (MSW) program; Bachelor’s in Nursing or Master’s degree preferred.
• Current and valid license to practice as a Registered Nurse in Texas or current and valid license as a Master Social Worker (LMSW) in Texas; LCSW preferred.
• Certification in Case Management required within two years of hire.
• Three years of experience in hospital-based nursing or social work.
• Experience in utilization management, case management, discharge planning, or cost/quality management preferred.
• Excellent interpersonal communication, negotiation, and leadership skills.
• Strong analytical, data management, and PC skills.
• Knowledge of discharge planning, utilization management, performance improvement, and managed care reimbursement.
• Understanding of pre-acute and post-acute care venues, community resources, and physician office routines.
• Demonstrated skills in motivational interviewing, change management, and time management.
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, patients, and families.
• Effective oral and written communication skills.