Case Manager I
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At Houston Methodist, the Case Manager (CM) I position is a licensed registered nurse (RN) who comprehensively plans for case management of a targeted patient population on a designated unit(s). 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 I holds joint accountability with 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.
PRIMARY JOB RESPONSIBILITIES
Job responsibilities labeled EF capture those duties that are essential functions of the job.
PEOPLE - 15%
- 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. (EF)
- Collaborates with staff from the interprofessional health care team concerning safety data to improve outcomes and the safe transition of care through effective patient handoffs and uses a structured format for regular communication with patients and families. (EF)
SERVICE - 25%
- Assesses all patients timely and thoroughly. Participates in daily Care Coordination Rounds, and identifies, communicates barriers to efficient patient throughput. (EF)
- 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. (EF)
- Initiates and facilitates referrals for home health care, hospice, and durable medical equipment. Consults with Social Worker to assess psychosocial needs associated with transition to alternative levels of care, ensuring discharge disposition is to the appropriate level. Facilitates transfers. (EF)
- Supports patients and families in preventing/resolving clinical or ethical issues. (EF)
QUALITY/SAFETY - 25 %
- 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 assessment and interventions efficiently and effectively. (EF)
- Plans for routine discharge and elevates emergent situations. (EF)
- Manages usual patient assignment and other unit demands, completes responsibilities in timely manner with accurate documentation, organizes multiple priorities and anticipates/plans for potential problems. (EF)
- Focuses on discharge domain by contributing to departmental targets for quality and safety measures on scorecard. (EF)
FINANCE - 25%
- Contributes to meeting departmental financial target on scorecard, with focus on length of stay. (EF)
- Performs review for medical necessity of admission, continued stay and resource use, appropriate level of care and program compliance using InterQual Hospital Severity of Illness and Intensity of Service Criteria or Milliman Care 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. (EF)
- Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay (EF)
GROWTH/INNOVATION - 10%
- Identifies and presents areas for improvement in patient care or department operations and offers solutions by participating in unit projects and activities. (EF)
- Identifies areas for improvement based on understanding of evidence-based practice literature. Initiates evidence-based practice/performance improvement projects based on these observations. (EF)
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.
- Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certificates, Licenses and Registrations section
- Bachelor's degree preferred
- Three (3) years hospital nursing clinical experience
- Case management experience preferred
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
- Texas RN license or temporary TX RN license, should obtain permanent license within 90 days. Compact license acceptable according to current Board of Nursing requirements.
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
- 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
- Maintains level of professional contributions as defined in Career Path program
Work AttireYes/NoUniformNoScrubsNoBusiness professionalYesOther (dept approved)No
On-Call*Yes, on a regular basis (for Non-Exempt or Exempt jobs)
*Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Event, etc) regardless of selection above.
May require travel withinYesHouston Metropolitan area
Houston Methodist Baytown Hospital, located 35 miles east of downtown Houston, is the area's only full-service hospital offering specialized medical care for patients at every stage in life. This 230 operating beds hospital with 15 operating rooms and over 1,700 employees brings Medical Center excellence and quality care close to East Harris and surrounding counties.
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