Supplemental Case Manager

5 days ago

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

At Memorial Hermann Health System, we are committed to delivering high-quality, patient-centered care. As a Supplemental Case Manager, you will play a vital role in facilitating patient care progression throughout the continuum.

Job Summary

The purpose of this position is to support physicians, primary medical homes, and interdisciplinary teams in coordinating patient care, with the goal of enhancing clinical outcomes and patient satisfaction while managing costs and providing timely information to payors. The role integrates and coordinates resource utilization management, care facilitation, and discharge planning functions. Additionally, the Supplemental Case Manager will help drive change by identifying areas where performance improvement is needed, such as day-to-day workflow, education, and process improvements. The position is responsible for coordinating a wide range of self-management support and providing information to update and maintain relevant disease registry activity. Accountable for a designated patient caseload, the Supplemental Case Manager will plan effectively to meet patient needs across the continuum, provide family support, manage length of stay, and promote efficient utilization of resources. Key Responsibilities
  • Coordinates/facilitates patient care progression throughout the continuum.
  • Works collaboratively and maintains active communication with physicians, nursing, and other members of the multidisciplinary 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.
  • Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate 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 caseload; 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 following on a timely basis:
    • 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 (e.g., discharge planning). 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 compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction, and quality indicators (e.g., readmission rates, unplanned return to OR, etc.).
  • Acts as preceptor/mentor to new hires. Assists in development of orientation schedule and helps identify individual needs for learning.
  • Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
  • Completes Utilization Management and Quality Screening for assigned patients.
  • Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Department standards.
  • Identifies at-risk populations using approved screening tool and follows established reporting procedures.
  • Monitors LOS and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.
  • Refers cases and issues to Care Management Medical Director in compliance with Department procedures and follows up as indicated.
  • Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients. Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.
  • Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.
  • Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.
  • Manages all aspects of discharge planning for assigned patients.
  • Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician.
  • Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
  • Ensures/maintains plan consensus from patient/family, physician, and payor.
  • Refers appropriate cases for social work intervention based on Department criteria.
  • Collaborates/communicates with external case managers.
  • Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment, and supplies.
  • Documents relevant discharge planning information in the medical record according to Department standards.
  • Facilitates transfer to other facilities as appropriate.
  • Actively participates in clinical performance improvement activities.
  • 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.
  • Other duties as assigned.

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