CASE MANAGER
Company: Houston Methodist West Hospital
Location: Cypress
Posted on: September 28, 2024
Job Description:
At Houston Methodist, the Case Manager (CM) position is a
registered nurse (RN) responsible for comprehensively planning for
case management, which includes care transitions and discharge
planning of a targeted patient population on a designated unit(s)
and/or service lines. This position works with the physicians and
interprofessional health care team to facilitate and maintain
compassionate, efficient, quality care and achievement of desired
treatment outcomes. The CM position holds joint accountability with
the social worker for discharge planning and continuity of care and
assures that admission and continued stay are medically necessary,
communicating clinical information to payors to ensure
reimbursement. PEOPLE ESSENTIAL FUNCTIONS
- Communicates in an active, positive and effective manner to all
health care team members and reports pertinent patient care and
family data in a comprehensive and unbiased manner; listens and
responds to the ideas of others.
- Collaborates with staff from the interprofessional health care
team concerning safety data to improve outcomes and the safe
transition of care. Uses a structured format for regular
communication with patients and families.
- Conducts self in a manner that is congruent with cultural
diversity, equity and inclusion principles. Contributes towards
improvement of department scores for employee engagement, i.e.
peer-to-peer accountability. SERVICE ESSENTIAL FUNCTIONS
- Assesses all patients timely and thoroughly. Participates in
daily Care Coordination Rounds (CCR), and identifies, communicates
barriers to efficient patient throughput. Supports patients and
families in preventing/resolving clinical or ethical issues.
- Facilitates discharge planning activities for assigned patients
and collaborates with the social worker and other members of the
interprofessional health care team, as well as patient and family,
on complex discharges. Maintains ownership of the discharge
planning process on assigned units.
- Initiates and facilitates referrals for home health care,
hospice, and durable medical equipment. Consults with Social Worker
Case Manager to assess psychosocial needs associated with
transition to alternative levels of care, ensuring discharge
disposition is to the appropriate level. Facilitates transfers.
QUALITY/SAFETY ESSENTIAL FUNCTIONS
- Modifies care based on continuous evaluation of the patient's
condition, demonstrates clinical problem-solving and critical
thinking, and makes decisions using evidence-based analytical
approach. Documents accurate assessment and interventions
efficiently and effectively.
- Plans for routine discharge and elevates emergent situations.
Manages usual patient assignment and other unit demands and
anticipates/plans for potential problems.
- Focuses on discharge domain by contributing to department and
hospital targets for quality, patient satisfaction and safety
measures. FINANCE ESSENTIAL FUNCTIONS
- Performs review for medical necessity of admission, continued
stay and resource use, appropriate level of care and program
compliance using nationally recognized screening guidelines.
Manages assigned patients in Observation Status, daily, informing
physicians of timely disposition options to assure maximum benefits
for patients and reimbursement for the hospital.
- Applies approved utilization criteria to monitor
appropriateness of admissions, level of care, resource utilization,
and continued stay.
- Participates in denial mitigation activities to ensure
appropriate reimbursement for services rendered.
- Contributes to meeting department and hospital financial
target, with focus on length of stay. Utilizes resources with cost
effectiveness and value creation in mind. Self-motivated to
independently manage time effectively and prioritize daily tasks,
assisting coworkers as needed. GROWTH/INNOVATION ESSENTIAL
FUNCTIONS
- Identifies areas for improvement based on understanding of
evidence-based practice literature. Initiates evidence-based
practice/performance improvement projects based on these
observations and offers solutions by participating in unit projects
and activities.
- Seeks opportunities to identify self-development needs and
takes appropriate action. Ensures own career discussions occur with
appropriate management. Completes and updates the My Development
Plan on an on-going basis.
This job description is not intended to be all-inclusive; the
employee will also perform other reasonably related business/job
duties as assigned. Houston Methodist reserves the right to revise
job duties and responsibilities as the need arises. EDUCATION
- 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 WORK EXPERIENCE
- Three years hospital nursing clinical experience
- Case management experience preferred LICENSES AND
CERTIFICATIONS - REQUIRED
- RN - Registered Nurse - Texas State Licensure and/or Compact
State Licensure within 60 days OR
- RN-Temp - Registered Nurse - Temporary State Licensure within
60 days KNOWLEDGE, SKILLS, AND ABILITIES
- Demonstrates the skills and competencies necessary to safely
perform the assigned job, determined through on-going 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, health care
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 skill
SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE
- Uniform No
- Scrubs No
- Business professional Yes
- Other (department approved) No ON-CALL
Note that employees may be required to be on-call during
emergencies (ie. DIsaster, Severe Weather Events, etc) regardless
of selection below.
- On Call Yes TRAVEL
Travel specifications may vary by department
- May require travel within the Houston Metropolitan area
Yes
- May require travel outside Houston Metropolitan area No Company
Profile: Houston Methodist West Hospital is committed to leading
medicine in West Houston, Katy and surrounding communities by
delivering the Houston Methodist standard of exceptional safety,
quality, service and innovation. The growing campus offers 253 beds
and access to the most innovative medical and surgical care
available, including cardiology and cardiovascular surgery;
neurology and neurosurgery; comprehensive cancer care; orthopedics
and sports medicine; gastroenterology; bariatrics; childbirth
center with level III NICU; emergency care; and advanced imaging.
Houston Methodist is an equal opportunity employer inclusive of
women, minorities, disabled persons and veterans. Equal Employment
Opportunity Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which
Houston Methodist is firmly bound. Houston Methodist will not
engage in discrimination against or harassment of any person
employed or seeking employment with Houston Methodist on the basis
of race, color, religion, sex, sexual orientation, gender identity,
national origin, age, disability, status as a protected veteran or
other characteristics protected by law. VEVRAA Federal Contractor -
priority referral Protected Veterans requested.
Keywords: Houston Methodist West Hospital, Houston , CASE MANAGER, Executive , Cypress, Texas
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