Case Manager; PRN

At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans case management for a target patient population on a designated unit(s). This position works with physicians and the interprofessional health‑care team to facilitate and maintain compassionate, efficient quality care and achieve desired treatment outcomes. The CM PRN holds joint accountability with social work for discharge planning and continuity of care, ensures that admission and continued stay are medically necessary, and communicates clinical information to payors to secure reimbursement.

The CM PRN helps drive change by identifying areas where performance improvement is needed (e.g., day‑to‑day workflow, education, process improvements, patient satisfaction).

Non‑exempt

• Education
  • Graduate of an education program approved by the credentialing body for the required credential(s) indicated below in the Certificates, Licenses and Registrations section.
• Experience
  • Three (3) years hospital clinical nursing experience, including two (2) years in case management.
• Licenses and Certifications
  • 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).
• Skills and Abilities
  • Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations.
  • Proficiency in speaking, reading, and writing English 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.
  • Strong assessment, organizational and problem‑solving skills evidenced by capacity to prioritize multiple tasks and role components.
  • Knowledge of Medicare, Medicaid and managed‑care requirements.
  • Comprehensive knowledge of community resources, health‑care financial and payer requirements/issues, and eligibility for state, local and federal programs.
  • Comprehensive 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.
  • Demonstrates critical thinking and makes decisions using an evidence‑based analytical approach in interactions with physicians, payors, patients, and families.
  • Well versed in the entire Microsoft Office Suite (Access, Excel, Outlook, PowerPoint, and Word).

• Collaborates with the physician and all members of the interprofessional health‑care team to facilitate care for a designated case load; monitors patient progress, intervening as needed to ensure that plans of care and services provided are patient‑focused, high quality, efficient, and cost‑effective; facilitates timely completion and reporting of diagnostic testing, completion of treatment plans and discharge plans, modification of plans of care as necessary to meet ongoing patient needs, assignment of appropriate levels of care, and completion of all required documentation in EPIC and MIDAS.
• Serves as a preceptor, when appropriate, and implements staff education specific to patient populations and unit processes; coaches and mentors other staff and students; serves as a resource for case‑management and social‑work resources and needs for the department and the hospital.

• Performs review for medical necessity of admission, continued stay, and resource use, appropriate level of care, and program compliance; identifies when services no longer meet Inter Qual or Milliman criteria, initiates discussion with attending physicians, coordinates with the external case manager to facilitate discharge planning, seeks assistance from the physician advisor if needed, and informs management of the possible need…