Supplemental Case Manager

1 day ago

Stafford, Texas, United States Memorial Hermann Health System Full time
Job Summary

The Memorial Hermann Health System is seeking a skilled Supplemental Case Manager to join our team. As a key member of our care management team, you will play a vital role in facilitating patient care progression throughout the continuum.

Working collaboratively with physicians, nursing staff, and other members of the multidisciplinary care team, you will address system problems impeding diagnostic or treatment progress, proactively identify and resolve delays and obstacles to discharge, and utilize advanced conflict resolution skills to ensure timely resolution of issues.

Key Responsibilities
  • Coordinates and facilitates patient care progression throughout the continuum.
  • Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient care.
  • Addresses/resolves system problems impeding diagnostic or treatment progress.
  • Proactively identifies and resolves delays and obstacles to discharge.
  • Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
  • Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load.
  • Monitors the patient's progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient-focused, high-quality, efficient, and cost-effective.
  • Facilitates the completion and reporting of diagnostic testing, completion of treatment plan and discharge plan, modification of plan of care, as necessary, to meet the ongoing needs of the patient, communication to third-party payors and other relevant information to the care team, assignment of appropriate levels of care, completion of all required documentation in TQ screens and patient records.
  • Documents key clinical path variances and outcomes which relate to areas of direct responsibility.
  • Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.
  • Leads the development, implementation, evaluation, and revision of clinical pathways and other Case Management tools as a member of the clinical resource/team.
  • Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials, and appeals.
  • Uses data to drive decisions and plan/implement performance improvement strategies related to Case Management for assigned patients, including fiscal, clinical, and patient satisfaction data.
  • Collects, analyzes, and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team.
  • Uses concurrent variance data to drive practice changes and positively impact outcomes.
  • Collects delay and other data for specific performance and/or outcome indicators as determined by Director of Outcomes Management.
  • Ensures safe care to patients, staff, and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity, and quality of service.
  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
  • Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann's service standards by providing safe, caring, personalized, and efficient experiences to patients and colleagues.
Requirements
  • Graduate of an accredited school of professional nursing required; Bachelor's of Nursing preferred; or graduate of an accredited Masters of Social Work program (MSW); 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.
  • Certification in Case Management required within two (2) years of hire into the Case Manager position.
  • Three (3) years of experience in hospital-based nursing or social work.
  • Experience in utilization management, case management, discharge planning, or other cost/quality management program preferred.
  • 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, disease or population management, and managed care reimbursement.
  • Understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre and post-acute care.
  • Demonstrated understanding of motivational interviewing and change management.
  • 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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