Case Manager
3 weeks ago
Position Overview
The Case Manager is integral to supporting physicians, primary medical homes, and interdisciplinary teams. This role facilitates patient care with the goal of improving clinical outcomes, patient satisfaction, and cost management while ensuring timely communication with payors. Responsibilities include coordinating resource utilization, care facilitation, and discharge planning, and driving performance improvements in areas such as workflow, education, and patient satisfaction. The Case Manager manages a specific patient caseload, planning effectively to meet patient needs, provide family support, and ensure efficient resource utilization across the care continuum.
Minimum Qualifications
Education:
- Graduate of an accredited nursing school (required)
- Bachelor of Nursing preferred
- Graduate of an accredited Master of Social Work program
Licenses/Certifications:
- Valid Texas RN license or LMSW (LCSW preferred)
- Case Management certification within two years of hire
Experience/Skills:
- Three years of nursing or social work experience, preferably in an acute hospital or similar clinical setting
- Experience in utilization management, case management, and discharge planning
- Excellent interpersonal, communication, and negotiation skills
- Leadership abilities and strong analytical skills
- Knowledge of discharge planning, case management, performance improvement, and managed care
- Familiarity with pre-acute and post-acute care venues and community resources
- Proficiency in motivational interviewing and change management
- Organizational and time management skills
- Ability to work independently and exercise sound judgment
- Effective oral and written communication skills
Principal Responsibilities
- Facilitate patient care progression and maintain active communication with the care team
- Identify and resolve system problems that impede diagnostic or treatment progress
- Use conflict resolution skills to ensure timely resolution of issues
- Monitor patient progress and intervene to ensure high-quality, efficient, and cost-effective care
- Complete and report diagnostic testing, treatment plans, and discharge plans promptly
- Document care activities in patient records
- Collaborate with medical, nursing, and ancillary staff to remove care delivery barriers
- Conduct utilization management and quality screening
- Monitor length of stay (LOS) and resource use, taking actions for continuous improvement
- Communicate with payors and resolve reimbursement issues
- Manage all aspects of discharge planning, including patient and family needs assessment
- Facilitate referrals for home health care, hospice, medical equipment, and other services
- Participate in clinical performance improvement activities and data collection
- Mentor new hires and support professional development within the team
- Adhere to all organizational policies and promote individual growth through continuing education
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