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Case Management Representative

Job Ref: 25702

Talent Area: Administrative/Clerical

Houston Methodist San Jacinto Hospital
Baytown, TX 77521

Area/Department: Qual Care Mgmt

Employment Type: Regular

Job Type: Full-Time

Organization: Houston Methodist

Work Shift: DAY

Work Week: M - F alternating weekends

Company Profile

Houston Methodist San Jacinto Hospital, located 35 miles southeast of Houston, is the area's only full-service hospital offering specialized medical care for patients at every stage in life. This 392 licensed bed hospital with 18 operating rooms, and over 1,400 employees, brings Medical Center excellence and quality care close to East Harris and surrounding counties.

Job Summary

Provides technical assistance to medical social workers/case managers to facilitate efficient utilization of resources and prompt processing of in-patient and post hospitalization care.  Assists social worker/case manager in identification of resources for placement including transportation and financial concerns.  Provides assistance in utilizing the electronic environment.  The person in this position also coordinates, oversees, records and transmits information pertinent to the resource management of patients. Anticipates independent actions necessary to provide competent and professional assistance to meet the needs of social workers/case managers and patients.


Young Adult (19-40 years), Middle Adult (40-65 years), and Mature Adult (65 years and older)



Patient/Family Involvement


1.    Interacts with patients/families in a professional manner in stressful and complex situations.

2.    Notifies patient/families of patient care conference

3.    Assists patients/families with documentation for Medical/Provider/Financial Assistance applications.

4.    Assists with post discharge  follow up


Placement Coordination


1.    Assists social workers/case managers in locating facilities or providers appropriate for patient’s needs and provides demographic information.

2.    Contacts facility to determine bed availability; providers for service/DME availability and communicates this information to social workers/case managers.

3.    Obtains information from patient’s chart needed for placement/provider referral at the direction of the social worker/case manager.  Ensures information is communicated in accordance with the Methodist Hospital System confidentiality policy.

  1. Follows up with phone calls and necessary paperwork to assure seamless referrals to outside facilities (Long Term Acute care, Acute Rehab, SNF, Home Health, etc) as directed by the CM/SW team.

5.    Ensures all necessary transfer/admission documentation is complete.

6.    Contacts outside facility on date of dismissal; informs facility/providers of patient’s discharge status.

  1. Facilitates acquisition of DME for post discharge care
  2. Facilitates post-discharge dialysis placement and follow-up
  3. Maintains awareness of payer/reimbursement practices and regulations that may impact patient’s plan of care.
  4. Confers with care coordinators and social workers to prioritize placement requests.



Transportation Coordination


1.    Independently obtains price quotes from airline, air ambulance, ground ambulance, and stretcher and wheelchair van services.

2.    Coordinates patient transportation, such as cab vouchers, metro passes, Greyhound bus vouchers, etc. and documents.

3.    Meets with patients and families to offer transportation options.

4.Contacts insurance company for transportation authorization as needed


Technical Support


1.    Assists social worker/case manager in copying and faxing activities to expedite patient progression. 

2.    Organizes and maintains the community resource files through current ordering of brochures, other written material and updates resource lists on an ongoing basis.

  1. Assists with distribution of the Medicare Notice of Discharges to identified patients, including capturing patient and their legal representative’s signature, answering questions regarding the appeal process

Managed Care Support

1.    Contacts business office/patient access services to obtain information of patient’s insurance carrier or to provide updated information.

2.    Contacts insurance carrier/managed care provider to determine benefits as requested by the social worker/case manager.

3.    Assesses need for social worker/case manager to advocate for benefits through insurance/managed care provider.

4.    Provides information to patients/families on insurance/managed care benefits and assesses need for further education by social worker/case manager.   

5.    Clarifies insurance information by identifying DME vendors, home health providers, hospice agencies in specified geographic locations.

  1. Supports and assists with concurrent insurance denials and appeals process, transmission of utilization reviews to insurance companies as necessary and documentation of authorization and denials.


On-Going Development


1.    Utilizes feedback as a performance improvement.

2.    Participates in quality improvement initiatives, collects data for use in departmental performance improvement as directed.

  1. Maintains routine communication with referring care coordinators, nurses, CM/SW or other clinical team members to keep them informed of the status of their request.
  1. Maintains timelines for follow up and prioritization of department projects and tasks
  2. Attends departmental meetings.
  3. Assists in the orientation of new staff and students.
  4. Demonstrates ability to obtain resources and communicate via computer information systems.
  5. Demonstrates SERVICE PRIDE standards. Demonstrates ICARE values.
  6. Follows all safety rules while on the job.  Reports accidents promptly and corrects   minor hazards.
  7. Performs other duties as assigned.




Minimum requirement:

High School graduate including courses in typing, English, and computer skills

Knowledge of medical terminology is desirable

Associates degree preferred



Minimum of six months to a year in a healthcare environment





Equal Employment Opportunity

Houston Methodist is an Equal Opportunity Employer.

Equal employment opportunity is a sound and just concept to which Houston Methodist is firmly bound. Houston Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Houston Methodist on the basis of  race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, status as a protected veteran or other characteristics protected by law.

VEVRAA Federal Contractor – priority referral Protected Veterans requested.