See more Collapse

Case Management Representative

2 months ago

Sugar Land, United States Houston Methodist Sugar Land Hospital Full time

At Houston Methodist, the Case Management Representative position is responsible for providing clerical assistance and data management support to the case management and social work department to facilitate efficient utilization of resources and discharge planning including referrals management, communication and collaboration with post-acute care providers, access to agencies and other community resources and transportation. This position may perform some secretary duties and performs a wide variety of administrative duties of a higher complexity in support of Case Management operations. In addition, the CM Rep position performs independent actions necessary to provide competent and professional assistance to meet the needs of social workers/case managers and patients. This position also coordinates, oversees, records, and transmits information pertinent to the resource management of patients to next level of care providers.

**PEOPLE ESSENTIAL FUNCTIONS**
- Serves as a department resource for questions related to case management activities. Communicates in an active, positive, and effective manner to all interprofessional health care team members. Reports pertinent patient care and family data in a comprehensive and unbiased manner. Performs phone call and communication triage, troubleshoots and routes issues to appropriate individuals, assists in resolution of non-clinical issues as needed
- Facilitates and arranges acquisition of post-acute needs, as directed, and in collaboration with the clinical team. Follows payor/reimbursement practices and regulations that may impact the patient's plan of care
- Provides appropriate and timely communication, update, and documentation to the referring personnel to keep them informed of the status of the request
- Conducts self in a manner that is congruent with cultural diversity, equity, and inclusion principles. Contributes towards improvement of department scores for employee engagement, i.e., peer-to-peer accountability

**SERVICE ESSENTIAL FUNCTIONS**
- Assists the department in distributing required notices, including the Medicare Notice of Discharge to patients, securing signatures on the form from the patient or their legal representative, and answering questions regarding the appeal process
- Distributes the Medicare Notice of Discharges to identified patients, including capturing patient and their legal representative's signatures, answering any questions regarding the appeal process
- Coordinates with the clinical staff to prioritize placement requests. Provides necessary documentation to facilitate post-acute services
- Assists with clerical and clinical functions for patients, physicians, and staff. Provides administrative support as needed, including scheduling follow-up appointments, and confirming the provision or delivery or post-acute services or equipment

**QUALITY/SAFETY ESSENTIAL FUNCTIONS**
- Participates in quality improvement initiatives and collects data for use in department performance improvement as directed. Maintains timelines for follow up and prioritization of department projects and tasks
- Updates and maintains resources, information and database or directories elated to post-acute providers and insurance contacts to facilitate timely communication and coordination as needed

**FINANCE ESSENTIAL FUNCTIONS**
- Informs social worker/case manager of the patients' available benefits through insurance/managed care provider. Assists in providing community resources/services to uninsured patients as requested Case Management staff
- Participates in reimbursement/certification and authorization-related activities as directed. Documents approvals and authorization numbers from payors. Logs communications and provides information to social workers and case managers, business office/patient access, etc. on insurance/managed care benefits
- Supports and assists with concurrent insurance denials and appeals process, transmission of utilization reviews to insurance companies, coordination of peer discussions as directed by the clinical team. Documents authorization, approvals, and denials

**GROWTH/INNOVATION ESSENTIAL FUNCTIONS**
- Maintains awareness of payor/reimbursement practices and regulations that may impact patient's plan of care and confers with care coordinators and social workers to prioritize placement requests
- 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**
- High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secon

We have other current jobs related to this field that you can find below

  • Case Manager

    2 weeks ago

    Sugar Land, United States PAM Health Full time

    Job DescriptionJob DescriptionCase Manager (RN)Full time opportunity Interviewing nowThe Case Manager is responsible for the interdisciplinary coordination of care for a designated patient population. The Case Manager performs reviews of all inpatient admission records to ensure proper utilization of hospital resources and determination of admission for...

  • Case Manager

    2 weeks ago

    Sugar Land, United States PAM Health Full time

    Case Manager (RN) Full time opportunity  Interviewing now The Case Manager is responsible for the interdisciplinary coordination of care for a designated patient population. The Case Manager performs reviews of all inpatient admission records to ensure proper utilization of hospital resources and determination of admission for appropriate level...

  • Case Management Director II

    3 weeks ago

    Sugar Land, United States Encompass Health Full time

    Job Description Job Description Case Management Director Career Opportunity Highly regarded for your Case Management Director expertise Are you an experienced and compassionate healthcare professional with a background in case management, seeking a career that aligns with your professional expertise and resonates with your personal values? As the Director of...

  • Nurse (Clinical/ Case Management)

    2 months ago

    Sugar Land, Texas, United States Military Treatment Facilities Under Dha Full time

    Serve as a member of a multidisciplinary team to provide assessment, planning, implementation, coordination, evaluation, and monitoring of patients for health options and services. Develop, analyze, integrate, monitor, and manage healthcare delivery systems through communication and use of resources to promote quality and cost-effectiveoutcomes across the...

  • Brand Marketing Representative

    1 week ago

    Sugar Land, United States Diamond Advanedge inc Full time

    Job DescriptionJob DescriptionDiamond Advanedge is a marketing and consulting company in Houston, representing some of the most significant business marketing firms in the nation. As a company, we’ve helped those fortune clients expand their footprint through innovative marketing strategies and cutting-edge advertising. Due to the growth we have seen over...

  • Brand Marketing Representative

    1 week ago

    Sugar Land, United States Diamond Advanedge inc Full time

    Job DescriptionJob DescriptionDiamond Advanedge is a marketing and consulting company in Houston, representing some of the most significant business marketing firms in the nation. As a company, we’ve helped those fortune clients expand their footprint through innovative marketing strategies and cutting-edge advertising. Due to the growth we have seen over...

  • AT&T Account Representative

    5 days ago

    Sugar Land, United States Diamond Advanedge inc Full time

    Job DescriptionJob DescriptionWe are urgently hiring an AT&T Account Representative to start with one of the most ICONIC Houston business firms!  We are a business development and account management firm located in the BEST city, Houston. Over the past decade, we have partnered up with brands that have become household names. As a result, we have directly...

  • Sales Representative

    1 month ago

    Sugar Land, United States Pure Barre Houston & Sugar Land Full time

    Job DescriptionJob DescriptionPure Barre is the national leader in barre fitness with more than 500+ franchise locations in the United States and Canada. Pure Barre provides more than just an amazing workout for its clients, it is also a place where we can go to feel empowered, be held accountable, find support, motivation and gratitude for ourselves and...

  • Client Support Representative

    5 days ago

    Sugar Land, United States Diamond Advanedge inc Full time

    Job DescriptionJob DescriptionThe Client Support Representative works on-site at our marketing & promotional events and provides support to the team at our corporate headquarters here in Houston. We specialize in customer retention and customer acquisitions for our clientele. Our clients span across a wide variety of industries, including home improvement,...

  • Analyst, Asset Management

    2 months ago

    Sugar Land, United States Avenue Living Asset Management Full time

    Avenue Living Asset Management is dedicated to sourcing, analyzing, and strategizing long-term investments. Our unique approach has led to rapid growth across North America now representing one of Canada's largest alternative asset managers. Since 2006, we have acquired over $5.5 billion in assets under management across a variety of sectors throughout...

  • Guest Service Representative

    2 months ago

    Sugar Land, United States Edit TX LLC dba Tide Cleaners Full time

    Job DescriptionJob DescriptionGuest Service Representative - Dry StoreReports To: Counter Manager & General ManagerEdit Holdings, LLC dba Tide Cleaners is seeking a Guest Service Representative to join our team! We are seeking individuals that enjoy working with people and as a team to represent Tide Dry Cleaners in the ideal manner and provide an enjoyable...

  • Law Firm Office Manager

    2 months ago

    Sugar Land, United States The Crash Team - The Galvan Law Firm Full time

    Job DescriptionJob DescriptionExciting opportunity to join a dynamic team with a HEART! A position for a Law Firm Office Manager is now available at our rapidly expanding personal injury law firm in the lively city of Sugar Land, TX. We place high value on traits such as integrity, excellence, and empathy. Our firm, located in Sugar Land, TX, specializing in...

  • Entry Level Sales Representative

    1 week ago

    Sugar Land, United States Diamond Advanedge inc Full time

    Job DescriptionJob DescriptionIf you seek a company that provides a supportive, long-term, and fun work environment, then Diamond Advanedge may be your next career opportunity.  Diamond Advanedge is a full-service sales and consulting firm that specializes in working with top telecommunications companies. At Diamond Advanedge, our team is constantly...

  • Entry Level Sales Representative

    1 week ago

    Sugar Land, United States Diamond Advanedge inc Full time

    Job DescriptionJob DescriptionIf you seek a company that provides a supportive, long-term, and fun work environment, then Diamond Advanedge may be your next career opportunity.  Diamond Advanedge is a full-service sales and consulting firm that specializes in working with top telecommunications companies. At Diamond Advanedge, our team is constantly...

  • Client Relations Representative-Entry Level

    2 weeks ago

    Sugar Land, United States Diamond AdvanEdge Full time

    LOCAL APPLICANTS ONLY Diamond AdvanEdge is currently looking for new Client Relations Representatives to join our growing team here in the Sugar Land area. In this entry-level position, the Client Relations Representative will act as a liaison between our clients and the customers with accuracy and efficiency. As a Client Relations Representative you will...

  • Client Relations Representative-Entry Level

    1 week ago

    Sugar Land, United States Diamond AdvanEdge Full time

    LOCAL APPLICANTS, ONSITE ROLEDiamond AdvanEdge is currently looking for new Client Relations Representatives to join our growing team here in the Sugar Land area. In this entry-level position, the Client Relations Representative will act as a liaison between our clients and the customers with accuracy and efficiency. As a Client Relations Representative you...

  • Client Relations Representative-Entry Level

    3 weeks ago

    Sugar Land, United States Diamond AdvanEdge Full time

    LOCAL APPLICANTS ONLYDiamond AdvanEdge is currently looking for new Client Relations Representatives to join our growing team here in the Sugar Land area. In this entry-level position, the Client Relations Representative will act as a liaison between our clients and the customers with accuracy and efficiency. As a Client Relations Representative you will be...

  • Client Relations Representative-Entry Level

    1 week ago

    Sugar Land, United States Diamond AdvanEdge Full time

    LOCAL APPLICANTS, ONSITE ROLE Diamond AdvanEdge is currently looking for new Client Relations Representatives to join our growing team here in the Sugar Land area. In this entry-level position, the Client Relations Representative will act as a liaison between our clients and the customers with accuracy and efficiency. As a Client Relations Representative...

  • Client Relations Representative-Entry Level

    2 weeks ago

    Sugar Land, United States Diamond AdvanEdge Full time

    LOCAL APPLICANTS, ONSITE ROLEDiamond AdvanEdge is currently looking for new Client Relations Representatives to join our growing team here in the Sugar Land area. In this entry-level position, the Client Relations Representative will act as a liaison between our clients and the customers with accuracy and efficiency. As a Client Relations Representative you...

  • Client Relations Representative-Entry Level

    2 weeks ago

    Sugar Land, United States Diamond AdvanEdge Full time

    LOCAL APPLICANTS, ONSITE ROLEDiamond AdvanEdge is currently looking for new Client Relations Representatives to join our growing team here in the Sugar Land area. In this entry-level position, the Client Relations Representative will act as a liaison between our clients and the customers with accuracy and efficiency. As a Client Relations Representative you...