Case Manager-Registered Nurse; RN

Case Manager-Registered Nurse (RN)

Location:

Houston Methodist Hospital, 6565 Fannin St., Houston TX, 77030

Job
-7772 | Job Shift: Day | Job Type: Full Time

At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN) responsible for comprehensively planning case management, which includes care transitions and discharge planning of a targeted patient population on one or more designated units and/or service lines. The CM works with physicians and the interprofessional health care team to facilitate and maintain compassionate, efficient, high‑quality care and achievement of desired treatment outcomes.

The CM shares joint accountability with the social worker for discharge planning and continuity of care and ensures that admission and continued stay are medically necessary, communicating clinical information to payors to secure reimbursement.

Exempt

• Graduate of an 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
• Case management experience preferred

• Registered Nurse (RN) – Texas State Licensure – Texas Board of Nursing; PSV Compact Licensure. Must obtain permanent Texas license within 60 days (if establishing Texas residency)

• 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 English necessary for essential functions of this job, especially where patient or employee safety is impacted
• Effectively communicates with patients, physicians, family members, and coworkers in a customer‑service focused manner using positive language principles
• Knowledge of Medicare, Medicaid, and Managed Care requirements
• Progressive knowledge of community resources, health care finance and payor requirements, 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
• Works independently and exercises sound judgment when interacting with physicians, payors, patients, and families
• Well versed in Microsoft Office Suite (Excel, Outlook, PowerPoint, Word)
• Strong assessment, organizational, and problem‑solving skills

• Communicates actively, positively, and effectively to all health care team members, reporting pertinent patient care and family data in a comprehensive, unbiased manner; listens and responds to others’ ideas
• Collaborates with interprofessional staff on safety data to improve outcomes and the safe transition of care, using a structured format for regular communication with patients and families
• Contributes to improvement of department scores for employee engagement and peer‑to‑peer accountability

• 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, collaborating with the social worker and other interprofessional team members, as well as patients and families, 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 the 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

• Modifies care based on continuous evaluation of the patient’s condition, demonstrates clinical problem‑solving…