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Case Manager Advanced
3 months ago
At Houston Methodist, the Case Manager (CM) Advanced position is a registered nurse (RN) responsible for promoting the achievement of optimal clinical and resource outcomes, accountable for a designated assignment that is considered more complex and resource intensive. This position has achieved an expert level at all the objectives delineated in the Case Manager and Case Manager Certified job roles and is responsible for facilitating appropriate lengths of stay (LOS) and reimbursement for all hospital admissions in accordance with set goals and objective. The CM Advanced position assures that admission and continued stay are medically necessary, communicating clinical information to payers to ensure reimbursement. The Advanced CM position analyzes variances to identify opportunities for improvement and acts as the key information and education resource for the interprofessional health care team. This position promotes and maintains compassionate, quality of care through collaboration with all service team members, patients and families and works with the leadership team for special project activities related but not limited to, throughput, readmissions, and utilization management to align with the visions and goals of the department and organization. The CM Advanced position will lead projects or perform specialized responsibilities as a regular part of their normal job responsibilities.
**PEOPLE ESSENTIAL FUNCTIONS**
- Promotes a positive work environment and leads the team to be a dynamic, team-focused work unit that actively helps one another to achieve optimal department results. Acts as a role model to team members exemplifying effective communication skills. Collaborates with all members of the patient care team by actively communicating and reporting pertinent patient care information and data in a comprehensive manner.
- Works with physician leadership and the interprofessional healthcare team for defined patient populations to develop clinical pathways, continuum care management programs, measurement and feedback of performance indicators for cost, quality and service and patient satisfaction.
- Serves as the primary information resource for case management staff, payors, physicians, other healthcare team members and customers. Acts as a formal preceptor/coach for new case management employees. Develops skills of team members and continually assists with improving skills, performance and outcomes. Provides feedback to management on team member performance and conduct.
- Conducts self in a manner that is congruent with cultural diversity, equity and inclusion principles. Collaborates with leadership team on recruitment and retention strategies and key initiatives to improve employee relations, participation and engagement. Initiates improvement of department scores for employee engagement, i.e., peer-to-peer accountability.
**SERVICE ESSENTIAL FUNCTIONS**
- Serves as a leader for comprehensive case management activities including assessing all patients and leading team to set discharge plan, participating in daily rounds or discussions, identifying and leading resolution of barriers to efficient patient throughput.
- Continuously reviews the total picture of the patient for opportunities for care facilitation and needs for discharge planning. Mentors others regarding specialty populations.
- Independently handles resolution of complex problems and issues. Serves as escalation support for novice staff. Implements and leads initiatives to improve patient and family satisfaction related to discharge question(s) on HCAHPS.
**QUALITY/SAFETY ESSENTIAL FUNCTIONS**
- Identifies need for case management and/or social work intervention and implements strategies that improve care coordination metrics (LOS reduction, discharges before 11am and readmission reduction) by using clinical expertise and high-risk screening tools.
- Actively participate in system-wide projects regarding Case Management related topics such as length of stay reduction, readmission prevention, utilization management denial mitigation and appeal resolution. Identifies opportunities for process improvement to improve the quality of case management and social work documentation, providing recommendations to meeting department and hospital targets for quality and safety. Works with the department leadership to create and/or enhance current operational and documentation of efficiencies to improve the quality of information in the medical record.
- Performs chart audits to assess compliance with department-specific tasks and documentation. Tracks and trends performance and reports to department leadership.
**FINANCE ESSENTIAL FUNCTIONS**
- Oversees the management of specific patient populations across the continuum, focusing on high-risk, high-cost patients. Takes leadership role in collaborating with employees to secure reimbursement for hospital services. Collaborates with department leadership on cost-reduction strategies. Leads effort
