System Float Pool

Case Manager-PRN
~18 shifts in a 6 week period (4 weekend shifts)
~ Must work 1 major holiday, 2 minor holidays
~ Magnet - ANCC Recognized Certification -- Case Management-related OR ACM - Accredited Case Manager (NBCM) REQUIRED

At Houston Methodist, the System Float Pool Case Manager (CM) Certified 1 position is a registered nurse (RN) responsible for comprehensively planning for case management of a targeted patient population on a designated unit(s) and/or service line. This position works with the physicians and interprofessional healthcare team to facilitate and maintain compassionate, efficient quality care and achievement of desired treatment outcomes. The CM Certified 1 position holds joint accountability with social workers 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. In addition to performing the duties of a CM, this position helps drive change by identifying areas where performance improvement is needed, e.g., day-to-day workflow, education, process improvements, and patient satisfaction.
Collaborates with the physician and all members of the interprofessional healthcare team to facilitate care for designated assignment; monitors the patient's progress, intervening as needed to ensure that the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective.

~ Serves as a preceptor and implements staff education specific to patient populations and unit processes; coaches and mentors other staff and students. Serves a resource for department and hospital. Provides education to physicians, nurses, and other healthcare providers on case management topics.

~ Conducts self in a manner that is congruent with cultural diversity, equity and inclusion principles. Initiates contributions towards improvement of department scores for employee engagement, i.e., 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 InterQual/Milliman l 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 for issuing Medicare Hospital Initiated Notice of Non-coverage.

~ Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay. Reviews level of care denials to identify trends and collaborate with team to recommend opportunities for process improvement.

~ Plans for routine/difficult discharge and anticipates/prevents and manages emergent situations.

~ Assessment and intervention to prevent or reduce readmission - completion of treatment plan and discharge plan - modification of plan of care as necessary to meet the ongoing needs of the patient - assignment of appropriate levels of care - completion of all required documentation in designated EMR and applications or programs - elimination of discharge barriers


QUALITY/SAFETY ESSENTIAL FUNCTIONS
~ Documents assessment and interventions efficiently and effectively. Proactively takes action to achieve continuous improvement and expedite care/facilitate discharge.

~ Performs post-discharge review by analyzing the inpatient record to ensure that compliance with quality indicators are met. Intervenes and takes appropriate action to foster real-time compliance with CMS guidelines and other performance measures associated with certification programs and other regulatory, national, regional or locally- sponsored quality programs. compliance with established governmental and/or institutional rules and regulations - analysis of problematic areas, and - actions taken to improve compliance

~ Conducts chart audits and performs peer-to-peer evaluations for continuous quality improvement.

~ Identifies opportunities to improve patient satisfaction with focus on discharge domain and collaborates with unit leadership to implement evidence-based patient engagement strategies.


Contributes to meeting department and hospital financial targets, with focus on length of stay.

~ Manages all patients in Observation Status, informing physicians of timely disposition options to assure maximum benefits for patients and reimbursement for the hospital.

~ Secures reimbursement for hospital services by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, state, and federal agencies. Offers innovative solutions through evidence-based practice/performance improvement projects and shared governance activities.

~ Ensures own career discussions occur with appropriate management. Bachelor's degree or higher from an accredited school of nursing

~ WORK EXPERIENCE
~ Five years hospital clinical nursing experience which includes two years in case management

RN-Temp - Registered Nurse - Temporary State Licensure within 60 days AND
Magnet - ANCC Recognized Certification -- Case Management-related OR
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

~ Comprehensive knowledge of Medicare, Medicaid and Managed Care requirements

~ Comprehensive knowledge of community resources, health care financial and payor 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

~ Competent computer skills of the entire Microsoft Office Suite (Access, Excel, Outlook, PowerPoint and Word)

TRAVEL**
**Travel specifications may vary by department**
May require travel within the Houston Metropolitan area Yes
May require travel outside Houston Metropolitan area No
Houston Methodist is one of the nation’s leading health systems and academic medical centers. Houston Methodist Hospital, its flagship academic hospital in the heart of the Texas Medical Center, and seven community hospitals throughout the greater Houston area. Houston Methodist also includes an academic institute, a comprehensive residency program, a global business division, numerous physician practices and several free-standing emergency rooms and outpatient facilities. Overall, Houston Methodist employs more than 27,000 employees and is supported by a wide variety of business functions that operate at the system level to help enable clinical departments to provide high quality patient care.
Houston Methodist is an equal opportunity employer inclusive of women, minorities, disabled persons and veterans.
Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law. VEVRAA Federal Contractor – priority referral Protected Veterans requested.