Case Manager

At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN) responsible for comprehensively assessing clinical condition and 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 multidisciplinary healthcare team to facilitate clinical care coordination and maintain compassionate, efficient, quality and safe patient care and achievement of desired treatment outcomes.

The CM position holds joint accountability with the social worker for discharge planning, coordination of care, and throughput, assuring that admission and continued stay are medically necessary. This position communicates clinical information to payors and post-acute care providers to ensure safe transition and continuity of care.

Exempt

• 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

• Three years hospital nursing clinical experience
• Acute care case management experience preferred

Required

• RN - Registered Nurse - Texas State Licensure - Texas Board of  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 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, healthcare 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 skills

• Communicates in an active, positive and effective manner to all healthcare team members and reports pertinent clinical patient care and family data in a comprehensive and unbiased manner; listens and responds to the ideas of others. Supports patients and families in preventing/resolving clinical or ethical issues.
• Collaborates with staff from the multidisciplinary care team concerning the discharge plan to improve outcomes and the safe transition of care. Uses a structured format for regular communication with patients and families.
• Communicates effectively with physicians, multidisciplinary care team, patients, and families to ensure safe and timely transitions of care.
• Contributes towards improvement of employee engagement as reflected by department scores, i.e., peer-to-peer accountability.

• Assesses all patients timely, per policy, and thoroughly. Reviews chart for medical necessity and facilitation of throughput and appropriate utilization of inpatient resources and services, etc. Initiates and facilitates referrals and transfers for home health care, hospice, durable medical equipment, and other post-acute services.
• Participates and is prepared to present barriers to efficient patient throughput in daily multi-disciplinary rounds (MDRs). Escalates appropriate discharge barriers to leadership and/or…