Senior Case Manager/Team Lead

4 weeks ago


Houston, Texas, United States Memorial Hermann Health System Full time

At Memorial Hermann Health System, we strive to deliver exceptional patient care while fostering a collaborative and supportive work environment. As a Senior Case Manager/Team Lead, you will play a vital role in promoting optimal clinical and resource outcomes for our patients.

Job Summary

The Senior Case Manager/Team Lead is responsible for overseeing the management of specific patient populations across the continuum, focusing on high-risk, high-cost patients. This role serves as a resource to the multidisciplinary team for the management of complex patients, working closely with physician leadership and the team to develop clinical pathways, continuum care management programs, and measurement and feedback of performance indicators for cost, quality, and service and patient satisfaction.

Key Responsibilities

  • Oversee the management of specific patient populations across the continuum, focusing on high-risk, high-cost patients.
  • Develop and implement clinical pathways, continuum care management programs, and measurement and feedback of performance indicators for cost, quality, and service and patient satisfaction.
  • Serve as a resource to the multidisciplinary team for the management of complex patients.
  • Collaborate with physician leadership and the team to develop and implement care management strategies.
  • Monitor and analyze patient outcomes, identifying opportunities for improvement and implementing changes as needed.
  • Develop and maintain relationships with payors, physicians, and other healthcare stakeholders to ensure seamless care coordination.
  • Stay up-to-date on industry trends, best practices, and regulatory requirements, applying this knowledge to improve patient care and outcomes.
  • Participate in quality improvement initiatives, contributing to the development and implementation of process improvements.
  • Collaborate with the care management team to ensure effective communication and coordination of patient care.
  • Develop and maintain accurate and timely documentation of patient care, including progress notes, treatment plans, and discharge plans.
  • Perform other duties as assigned by the Director of Case Management.

Requirements

  • Bachelor's degree in Nursing (BSN) or Social Work (MSW) required; Master's degree preferred.
  • Current and valid license to practice as a Registered Nurse in the state of Texas or current and valid license as a Master Social Worker (LMSW) in the state of Texas required, LCSW preferred.
  • Case Manager Certification required.
  • Three (3) years of experience in utilization management, case management, discharge planning, or other cost/quality management program.
  • Minimum three (3) years of experience in hospital-based nursing or social work.
  • Excellent interpersonal communication and negotiation skills.
  • Demonstrated leadership skills.
  • Strong analytical, data management, and PC skills.
  • Current working 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.
  • Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
  • Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families.
  • Effective oral and written communication skills.


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