Case Manager
3 weeks ago
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 facilitate and maintain compassionate, efficient, quality care and achievement of desired treatment outcomes. The CM position holds joint accountability with the social worker 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.
Houston Methodist Standard
PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.
HOUSTON METHODIST EXPERIENCE EXPECTATIONS
- Provide personalized care and service by consistently demonstrating our I CARE values:
- INTEGRITY: We are honest and ethical in all we say and do.
- COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
- ACCOUNTABILITY: We hold ourselves accountable for all our actions.
- RESPECT: We treat every individual as a person of worth, dignity, and value.
- EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.
- Practices the Caring and Serving Model
- Delivers personalized service using HM Service Standards
- Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)
- Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.
- Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job
- Displays cultural humility, diversity, equity and inclusion principles
- Actively supports the organization's vision, fulfills the mission and abides by the I CARE values
- Displays cultural humility, diversity, equity and inclusion principles
- Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job
- Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.
- Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)
- Delivers personalized service using HM Service Standards
- Communicates in an active, positive and effective manner to all health care team members and reports pertinent patient care and family data in a comprehensive and unbiased manner; listens and responds to the ideas of others.
- Collaborates with staff from the interprofessional health care team concerning safety data to improve outcomes and the safe transition of care. Uses a structured format for regular communication with patients and families.
- 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.
- Collaborates with staff from the interprofessional health care team concerning safety data to improve outcomes and the safe transition of care. Uses a structured format for regular communication with patients and families.
- Assesses all patients timely and thoroughly. Participates in daily Care Coordination Rounds (CCR), and identifies, communicates barriers to efficient patient throughput. Supports patients and families in preventing/resolving clinical or ethical issues.
- Facilitates discharge planning activities for assigned patients and collaborates with the social worker and other members of the interprofessional health care team, as well as patient and family, on complex discharges. Maintains ownership of the discharge planning process on assigned units.
- Initiates and facilitates referrals for home health care, hospice, and durable medical equipment. Consults with Social Worker Case Manager to assess psychosocial needs associated with transition to alternative levels of care, ensuring discharge disposition is to the appropriate level. Facilitates transfers.
- Facilitates discharge planning activities for assigned patients and collaborates with the social worker and other members of the interprofessional health care team, as well as patient and family, on complex discharges. Maintains ownership of the discharge planning process on assigned units.
- Modifies care based on continuous evaluation of the patient's condition, demonstrates clinical problem-solving and critical thinking, and makes decisions using evidence-based analytical approach. Documents accurate assessment and interventions efficiently and effectively.
- Plans for routine discharge and elevates emergent situations. Manages usual patient assignment and other unit demands and anticipates/plans for potential problems.
- Focuses on discharge domain by contributing to department and hospital targets for quality, patient satisfaction and safety measures.
- Plans for routine discharge and elevates emergent situations. Manages usual patient assignment and other unit demands and anticipates/plans for potential problems.
- Performs review for medical necessity of admission, continued stay and resource use, appropriate level of care and program compliance using nationally recognized screening guidelines. Manages assigned patients in Observation Status, daily, informing physicians of timely disposition options to assure maximum benefits for patients and reimbursement for the hospital.
- Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay.
- Participates in denial mitigation activities to ensure appropriate reimbursement for services rendered.
- Contributes to meeting department and hospital financial target, with focus on length of stay. Utilizes resources with cost effectiveness and value creation in mind. Self-motivated to independently manage time effectively and prioritize daily tasks, assisting coworkers as needed.
- Participates in denial mitigation activities to ensure appropriate reimbursement for services rendered.
- Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay.
- Identifies areas for improvement based on understanding of evidence-based practice literature. Initiates evidence-based practice/performance improvement projects based on these observations and offers solutions by participating in unit projects and 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.
Qualifications
- Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section.
- Bachelor's degree preferred
- Three years hospital nursing clinical experience
- Case management experience preferred
- 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
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
- Knowledge of Medicare, Medicaid and Managed Care requirements
- Progressive knowledge of community resources, health care financial and payor requirements/issues, and eligibility for state, local and federal programs
- Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement
- Understanding of pre-acute and post-acute venues of care and post-acute community resources
- Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families
- Well versed in computer skills of the entire Microsoft Office Suite (Excel, Outlook, PowerPoint and Word)
- Strong assessment, organizational and problem-solving skill
- Well versed in computer skills of the entire Microsoft Office Suite (Excel, Outlook, PowerPoint and Word)
- Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families
- Understanding of pre-acute and post-acute venues of care and post-acute community resources
- Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement
- Progressive knowledge of community resources, health care financial and payor requirements/issues, and eligibility for state, local and federal programs
- Knowledge of Medicare, Medicaid and Managed Care requirements
- 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
- 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
WORK ATTIRE
- Uniform No
- Scrubs No
- Business professional Yes
- Other (department approved) No
*Note that employees may be required to be on-call during emergencies (ie. DIsaster, Severe Weather Events, etc) regardless of selection below.
- On Call* Yes
**Travel specifications may vary by department**
- May require travel within the Houston Metropolitan area Yes
- May require travel outside Houston Metropolitan area No
Since its founding in 1919, Houston Methodist Hospital has earned worldwide recognition. Houston Methodist Hospital is affiliated with the Weill Medical College of Cornell University and New York-Presbyterian Hospital, one of the nation's leading centers for medical education and research. In 2020, U.S. News & World Report named Houston Methodist Hospital to its top ranked Honor Roll for the fourth time and second consecutive year. 2020 also marked the ninth year in a row Houston Methodist Hospital has been named the No. 1 hospital in Texas. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 952 operating beds, 85 operating rooms and over 8,000 employees, Houston Methodist offers complete care for patients from around the world.
The same high-quality care for which Houston Methodist is known is available at several Emergency Care Centers in Houston and the surrounding areas. These Emergency Care Centers house exam rooms, full digital radiography suite, low radiation dose 16-slice CT scan, ultrasound and a full on-site stat chemistry lab.
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