Certified Case Manager

2 days ago

Spring, United States HealthEcareers - Client Full time

At Houston Methodist, the Case Manager (CM) Certified 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 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, patient satisfaction.

PEOPLE ESSENTIAL FUNCTIONS
  • 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., peer-to-peer accountability.

SERVICE ESSENTIAL FUNCTIONS
  • 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. Facilitates timely:
    - 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. Provides reports, as needed, to appropriate parties showing:
    - 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.

FINANCE ESSENTIAL FUNCTIONS
  • Monitors Length of Stay (LOS) for assigned cases on an ongoing basis. Identifies population and/or service-specific trends impacting LOS and addresses/resolves problems impeding treatment progress. 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. Responds to requests for information, monitors covered days, initiates review to assure that all days are covered and reimbursable.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS
  • Identifies opportunity for practice changes. Offers innovative solutions through evidence-based practice/performance improvement projects and shared governance activities.
  • Seeks opportunities to identify self-development needs and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates the My Development Plan on an on-going basis.

This job description is not intended to be all-inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.EDUCATION
  • Bachelor's degree or higher in nursing
  • Master's degree preferred

WORK EXPERIENCE
  • Five years hospital clinical nursing experience which includes two years in case management
LICENSES AND CERTIFICATIONS - REQUIRED
  • RN - Registered Nurse - Texas State Licensure and/or Compact State Licensure within 60 days OR
  • RN-Temp - Registered Nurse - Temporary State Licensure within 60 days AND
  • Magnet - ANCC Recognized Certification -- Case Management-related OR
  • ACM - Accredited Case Manager (NBCM) -- National Board for Case Management
KNOWLEDGE, SKILLS, AND ABILITIES
  • 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

  • Certified Case Manager

    22 hours ago

    Silver Spring, Maryland, United States HealthEcareers - Client Full time

    Job SummaryWe are seeking a highly skilled and experienced Certified Case Manager to join our team at HealthEcareers - Client. As a key member of our healthcare team, you will be responsible for providing comprehensive case management services to patients, ensuring seamless transitions from hospital to home or other care settings.Key...

  • Case Manager

    2 months ago

    Silver Spring, United States Jobot Full time

    Case Manager / $$$$ / Great Benefits / Growth and Fun EnvironmentThis Jobot Job is hosted by: Joey CiufoAre you a fit? Easy Apply now by clicking the "Apply Now" button and sending us your resume.Salary: $20 - $30 per hourA bit about us:A full-service law firm specializing in various areas of legal practice offers comprehensive services tailored to meet the...

  • Case Manager

    2 weeks ago

    Silver Spring, United States Jobot Full time

    Case Manager / $$$$ / Great Benefits / Growth and Fun EnvironmentThis Jobot Job is hosted by: Joey CiufoAre you a fit? Easy Apply now by clicking the "Apply Now" buttonand sending us your resume.Salary: $20 - $30 per hourA bit about us:A full-service law firm specializing in various areas of legal practice offers comprehensive services tailored to meet the...

  • Case Manager

    2 months ago

    Silver Spring, United States Jobot Full time

    Case Manager / $$$$ / Great Benefits / Growth and Fun EnvironmentThis Jobot Job is hosted by: Joey CiufoAre you a fit? Easy Apply now by clicking the "Apply Now" button and sending us your resume.Salary: $20 - $30 per hourA bit about us:A full-service law firm specializing in various areas of legal practice offers comprehensive services tailored to meet the...

  • Certified Financial Planner

    1 month ago

    Spring Hill, United States Campbell & Company, Wealth Advisors, and Certified Public Accountants Full time

    Title: Financial Service Advisor - Licensed Series 65.Functions: Client Servicing & Advisor Support.Type: Full Time.Salary: Salary + Variable Compensation Package.Experience: FINRA Series 65 Required, CFP designation required.Reports To: Principal of Practice.Location: Spring Hill, Florida.Position Highlights:Campbell & Company, Wealth Advisors and CPAs is...

  • RN Case Manager

    1 month ago

    Spring, United States A Hug Away Full time $85,000 - $90,000

    About Us: A Hug Away Healthcare is a leading provider of home health and hospice services. We are seeking a compassionate and experienced Home Health and Hospice Nurse to join our team. This role involves providing high-quality care to patients in their homes and managing their cases effectively using the WellSky EMR system.Key Responsibilities:Provide...

  • Case Manager

    2 days ago

    Spring, United States HealthEcareers - Client Full time

    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...

  • Case Manager

    2 weeks ago

    Spring, United States HealthEcareers - Client Full time

    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...

  • Certified Financial Planner

    4 weeks ago

    Spring Hill, United States Campbell & Company, Wealth Advisors, and Certified Public Accountants Full time

    Title: Financial Service Advisor - Licensed Series 65.Functions: Client Servicing & Advisor Support.Type: Full Time.Salary: Salary + Variable Compensation Package.Experience: FINRA Series 65 Required, CFP designation required.Reports To: Principal of Practice.Location: Spring Hill, Florida.About Campbell & Company:Welcome to Campbell & Company Wealth...

  • Case Manager

    4 weeks ago

    Spring Hill, United States Springbrook Behavioral Hospital Full time

    *Job description*The Case Manager is responsible for managing discharge planning for patients upon discharge from treatment. The Case Manager is responsible for patient caseload and providing educational or life-skills groups to patients. The Case Manager could have the responsibility for maintaining communication with the referral source and other services...

  • Case Manager

    5 days ago

    Silver Spring, Maryland, United States Service Coordination, Inc. Full time

    Job Description**About Us**Service Coordination, Inc. is a leading provider of human services, dedicated to empowering individuals with disabilities to live independently and achieve their full potential. We are seeking a highly motivated and compassionate Case Manager to join our team.Job SummaryThe Case Manager will be responsible for providing...

  • Continuum Care Case Manager

    3 weeks ago

    Mill Spring, United States Pavillon International Full time

    Job DescriptionJob DescriptionPavillon's drug and alcohol treatment program located in Mill Spring, North Carolina seeks full-time Addictions Recovery Continuum Care Case Manager.Education Requirements: SA certified, licensed in North Carolina preferred and one year full-time, wage-earning experience in substance abuse treatment or substance abuse...

  • Case Manager IV

    3 months ago

    Big Spring, United States Texas Department of Aging & Disability Services Full time

    Job Description: Would you thrive in an environment where you learn and grow personally and professionally all while helping make a positive impact on people’s lives? Do you appreciate being around others like yourself who are dependable, trustworthy, hard workers who believe in the value of each other, teamwork, and inclusivity? HSCS is dedicated to...

  • Bilingual Senior Case Management Supervisor

    2 weeks ago

    Silver Spring, Maryland, United States National Youth Advocate Program Full time

    Position OverviewLocationSilver Spring, MDEducation RequirementBachelor's DegreeCompensation$70,000.00SectorNonprofit - Social ServicesAbout National Youth Advocate ProgramWe prioritize the well-being of children, youth, and families as a fundamental principle and seek individuals who share this commitment.Enjoy 22 Days Off Annually Plus 11 Paid Holidays...

  • Healthcare Case Coordinator

    2 weeks ago

    Spring Valley, Illinois, United States Molina Healthcare Full time

    Position OverviewWe are in search of a qualified Social Work or Registered Nurse Case Manager to support our Health Plan operations. This role is essential in managing our Medicaid population effectively.Key ResponsibilitiesConduct comprehensive assessments of members to determine eligibility for case management services based on clinical evaluations and...

  • Bilingual Lead Case Manager

    1 month ago

    Silver Spring, United States National Youth Advocate Program Full time

    Job DetailsJob Location Silver Spring, MD Education Level 4 Year Degree Salary Range $70,000.00 Job Category Nonprofit - Social Services Working At NYAP NYAP's commitment to doing what is best for children, youth and their families is a core value and one that we look for in our newest team members. 22 Days Off Each Year! Plus 11 Paid Holidays Per Year!...

  • Healthcare Case Coordinator

    2 weeks ago

    Spring Valley, Illinois, United States Molina Healthcare Full time

    Position OverviewWe are looking for a dedicated Social Work or Registered Nurse Case Manager to support our Medicaid population within Molina Healthcare. This role is crucial for ensuring that our members receive comprehensive care tailored to their needs.Key ResponsibilitiesConduct thorough assessments of members to determine eligibility for case management...

  • Case Manager for Law Firm

    1 month ago

    Silver Spring, United States Ultimate Staffing Full time

    Ultimate Staffing is seeking a dedicated and detail-oriented Case Manager for a possible Temp-to-Hire position in Silver Spring. The Case Manager will be responsible for managing client cases from intake to settlement or trial. This role requires strong organizational skills, excellent communication abilities, and a good understanding of personal injury law...

  • Case Manager for Law Firm

    1 month ago

    Silver Spring, United States Ultimate Staffing Full time

    Ultimate Staffing is seeking a dedicated and detail-oriented Case Manager for a possible Temp-to-Hire position in Silver Spring. The Case Manager will be responsible for managing client cases from intake to settlement or trial. This role requires strong organizational skills, excellent communication abilities, and a good understanding of personal injury law...

  • Client Relations Case Manager

    1 week ago

    Silver Spring, Maryland, United States Jobot Full time

    Legal Case Manager / Competitive Salary / Excellent Benefits / Opportunities for AdvancementThis Jobot Job is hosted by: Joey CiufoAre you a fit? Easy Apply now by clicking the "Apply Now" buttonand sending us your resume.Salary: $20 - $30 per hourAbout Us:We are a comprehensive legal practice dedicated to providing exceptional services across various legal...