About the position
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. The Case Manager 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. They collaborate with staff from the interprofessional health care team concerning safety data to improve outcomes and the safe transition of care. The CM conducts self in a manner that is congruent with cultural diversity, equity and inclusion principles and contributes towards improvement of department scores for employee engagement, i.e. peer-to-peer accountability. In terms of service, the CM assesses all patients timely and thoroughly, participates in daily Care Coordination Rounds (CCR), and identifies, communicates barriers to efficient patient throughput. They support patients and families in preventing/resolving clinical or ethical issues and facilitate discharge planning activities for assigned patients, collaborating with the social worker and other members of the interprofessional health care team, as well as patient and family, on complex discharges. The CM maintains ownership of the discharge planning process on assigned units and initiates and facilitates referrals for home health care, hospice, and durable medical equipment. The CM 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 approaches. They document accurate assessment and interventions efficiently and effectively, plan for routine discharge, and elevate emergent situations. The CM manages usual patient assignments and other unit demands while anticipating and planning for potential problems, focusing on discharge domains by contributing to department and hospital targets for quality, patient satisfaction, and safety measures. In terms of finance, the CM performs reviews for medical necessity of admission, continued stay, and resource use, ensuring appropriate level of care and program compliance using nationally recognized screening guidelines. They manage assigned patients in Observation Status, informing physicians of timely disposition options to assure maximum benefits for patients and reimbursement for the hospital. The CM applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay, participating in denial mitigation activities to ensure appropriate reimbursement for services rendered. They contribute to meeting department and hospital financial targets, with a focus on length of stay, utilizing resources with cost-effectiveness and value creation in mind.
Responsibilities
- Comprehensively plan for case management including care transitions and discharge planning.
- Collaborate with physicians and interprofessional health care team to facilitate quality care and desired treatment outcomes.
- Communicate effectively with health care team members and report pertinent patient care data.
- Participate in daily Care Coordination Rounds (CCR) and identify barriers to patient throughput.
- Facilitate discharge planning activities and collaborate with social workers and other team members.
- Maintain ownership of the discharge planning process on assigned units.
- Initiate and facilitate referrals for home health care, hospice, and durable medical equipment.
- Perform reviews for medical necessity of admission and continued stay.
- Document accurate assessments and interventions efficiently and effectively.
- Manage assigned patients in Observation Status and inform physicians of disposition options.
Requirements
- Bachelor's degree preferred.
- Three years hospital nursing clinical experience.
- Case management experience preferred.
- RN - Registered Nurse - Texas State Licensure and/or Compact State Licensure within 60 days.
- Sufficient proficiency in speaking, reading, and writing the English language.
- Knowledge of Medicare, Medicaid and Managed Care requirements.
- Progressive knowledge of discharge planning, utilization management, and case management.
- Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients.
Nice-to-haves
- Experience with electronic health records (EHR) systems.
- Knowledge of community resources and health care financial issues.
- Experience in performance improvement projects.
Benefits
- Health insurance coverage.
- 401k retirement savings plan.
- Paid time off and holidays.
- Tuition reimbursement for further education.
- Professional development opportunities.
