Case Management Representative

At Houston Methodist, the Case Management Representative position is responsible for providing clerical assistance and data management support to the case management and social work department to facilitate efficient utilization of resources and discharge planning including referrals management, communication and collaboration with post-acute care providers, access to agencies and other community resources and transportation. This position may perform some secretary duties and performs a wide variety of administrative duties of a higher complexity in support of Case Management operations.

In addition, the CM Rep position performs independent actions necessary to provide competent and professional assistance to meet the needs of social workers/case managers and patients. This position also coordinates, oversees, records, and transmits information pertinent to the resource management of patients to next level of care providers.

Non-exempt

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)
• Associate degree preferred

• Two years of experience in any of the following: service recovery, insurance verification, working with patient information, having patient contact, and/or general health care coordination responsibilities within a healthcare environment
• Previous experience in hospital setting and/or Case Management

• 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
• Some knowledge of community resources
• Must be able to operate within a Microsoft Office environment. Proficiency in MS Outlook and MS Word/Excel, knowledge of Medical Terminology
• Excellent telephone, oral and written communication skills, time management and prioritization skills
• Able to learn new skills effectively
• Ability to work independently while collaborating with other team members and exercise sound judgment in interactions with physicians, payors, and patients and their families
• Strong organizational and problem-solving skills

• Serves as a department resource for questions related to case management activities. Communicates in an active, positive, and effective manner to all interprofessional health care team members. Reports pertinent patient care and family data in a comprehensive and unbiased manner. Performs phone call and communication triage, troubleshoots and routes issues to appropriate individuals, assists in resolution of non-clinical issues as needed
• Facilitates and arranges acquisition of post-acute needs, as directed, and in collaboration with the clinical team. Follows payor/reimbursement practices and regulations that may impact the patient’s plan of care
• Provides appropriate and timely communication, update, and documentation to the referring personnel to keep them informed of the status of the request
• Contributes towards improvement of department scores for employee engagement, i.e. peer-to-peer accountability.

• Assists the department in distributing required notices, including the Medicare Notice of Discharge to patients, securing…