Care Management Coordinator, Care Management, Full-Time

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
The purpose of the Case Manager position is to support the physician, primary medical homes, and interdisciplinary teams. Facilitates patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction). Accountable for a designated patient caseload and plans effectively in order to meet patient needs across the continuum, provide family support, manage the length of stay, and promote efficient utilization of resources. Graduate of an accredited school of professional nursing required; Bachelors of Nursing preferred, or graduate of an accredited Master of Social Work program
Three (3) years of nursing or social work experience acute hospital-based preferred, or three (3) years of experience comparable clinical setting (i.e. ambulatory surgery center, infusion/dialysis clinic, Federally Qualified Health Clinic (FQHC), skilled nursing facility, or wound clinic)
Experience in utilization management, case management, discharge planning or other cost/quality management program preferred
Strong analytical, data management and PC skills
Current working knowledge of discharge planning, utilization management, case management, performance improvement, disease or population management and managed care reimbursement
Understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre and post acute care. Coordinates/facilitates patient care progression throughout the continuum.
Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient care.
Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load. Monitors the patient's progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
Completes and reports diagnostic testing, Completes treatment plan and discharge plan, Modifies plan of care as necessary, to meet the ongoing needs of the patient, Communicates to third party payors and other relevant information to the care team.
Assigns appropriate levels of care.
Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
Completes Utilization Management and Quality Screening for assigned patients.
Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Department standards.
Identifies at-risk populations using approved screening tool and follows established reporting procedures. Refers cases and issues to Care Management Medical Director in compliance with Department procedures and follows up as indicated.
Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients.
Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.
Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.
Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.
Manages all aspects of discharge planning for assigned patients.
Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician.
Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation.
Refers appropriate cases for social work intervention based on Department criteria.
Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment and supplies.
Documents relevant discharge planning information in the medical record according to Department standards.
Facilitates transfer to other facilities as appropriate.
Actively participates in clinical performance improvement activities.
Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.
Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data.
Collects, analyzes and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team.
Uses concurrent variance data to drive practice changes and positively impact outcomes.
Collects delay and other data for specific performance and/or outcome indicators as determined by Director of Outcomes Management. Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning).
Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.
Leads the development, implementation, evaluation and revision of clinical pathways and other Case management tools as a member of the clinical resource/team.
Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators (e.g., Assists in development of orientation schedule and helps identify individual needs for learning.
Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
serves as preceptor, mentor and resource to less experienced staff.
Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences.