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Case Management Coordinator
Job Ref # 20067
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Location:
Houston Methodist Hospital
6565 Fannin St
Houston, TX 77030

Category: Administrative

Job Type: Full-Time

Posted Date: Jan. 12, 2022

JOB SUMMARY
At Houston Methodist, the Case Management (CM) Coordinator position is a proficient CM representative that provides technical, clerical and data management support to the case management and social work department staff to facilitate efficient utilization of resources and discharge planning. This position performs the duties and responsibilities of a CM Representative, in addition to a wide variety of duties of a higher complexity in support of Case Management operations including referrals management, collaboration with post-acute care providers, access to agencies and other community resources and transportation. In addition, the CM Coordinator position anticipates independent actions necessary to provide competent and professional assistance to meet the needs of social workers/case managers and patients. This position also coordinates, oversees, records and transmits information pertinent to the resource management of patients to next level of care providers. The CM Coordinator position serves as the mentor/preceptor to other CM representatives, resulting in the delivery of exceptional patient care and adherence to standards of practice for optimal patient safety, quality outcomes, and customer service.

Requirements:

PRIMARY JOB RESPONSIBILITIES

PEOPLE - 20%

  1. Role models as a preceptor and implements staff education specific to patient populations and unit processes; coaches and mentors other staff. Functions a resource for case management and social work resources and needs for the department and the hospital. Exemplifies/leads teamwork by responding positively to requests for assistance. Fosters staff engagement by demonstrating active listening, requesting and acknowledging feedback, making equitable decisions, providing rationale when appropriate, and supporting organizational. (EF)
  2. Arranges, expedites and completes acquisition of post-acute care needs or secures insurance authorization, as directed, confirming with social workers and case managers, and ancillary departments, based on physician orders, payor/reimbursement practices and regulations that may impact the patient's plan of care. (EF)
  3. Facilitates designing and redesigning of CM representative processes and workflow. Actively participates in making recommendations for improving working relationships in the department, hospital, vendors, and post-acute providers. Leads contributions with leadership to identify workflow opportunities, assisting with recruitment and retention efforts, including to improve employee engagement department scores for CM representatives through peer-to-peer accountability. (EF)

SERVICE - 30%
  1. Provides necessary transfer/admission documentation. Reviews for accuracy and completion. Supports clerical and clinical functions for patients, physicians and staff. Provides administrative assistance, as needed, including scheduling follow-up appointments or providing clinical updates to payors, as needed Initiates efficiency initiatives for durable medical delivery process. (EF)
  2. Provides front-line problem resolution to straightforward questions or customer service needs. Provides guidance to payors/ancillary partners and/or CM Representatives on service standards and service recovery. Partners with leadership to implement best practices to deliver unparalleled service. (EF)
  3. Tracks and trends service failures. Articulates and takes action for service gaps to leadership and along with recommendations for improvement. Collaborates with the leadership team to develop strategies to maximize efficiency and remove barriers to ensure effectiveness of post-acute care referrals or minimize denials or delays. (EF)
  4. Participates in action plans for transition of care/discharge questions for patient satisfaction. Identifies opportunities to improve the customer experience. Contributes towards improving department scores for patient satisfaction on unit-based scorecard through peer-to-peer accountability. (EF)

QUALITY/SAFETY - 15%
  1. Serves as a role models for situational awareness, using teachable moments to improve safety. Participates in quality improvement initiatives and collects data for use in department performance improvement as directed. Contributes to identification of corrective action and improvement activities to meet department and hospital targets for quality and safety, collaborating with the interprofessional health care team. (EF)
  2. Collaborates with the leadership team to develop opportunities to improve documentation of insurance correspondence and compliance with payors/appeals, distribution of regulatory notices, including the CMS Important Message from Medicare, Medicare Outpatient Observation Notice, etc. (EF)

FINANCE - 30%
  1. Proactively secures reimbursement/certification and authorization-related needs, independently and escalates to management if needed. Documents approvals and authorization numbers from payors. Logs communications and provides information to social workers and case managers, business office/patient access, etc. on insurance/managed care benefits and post-acute care needs. (EF)
  2. Streamlines concurrent insurance denials and/or appeals process, in collaboration with management and nursing staff. Develops and implements best practices to ensure timely and accurate EMR documentation of authorization, approvals, and denials and recommends strategies for improvement. (EF)
  3. Identifies trends by payor and reports findings to management for further. Provides information to patients/families on insurance/managed care benefits and assesses need for further education by social worker/case manager. (EF)
  4. Self-motivated to independently manage time effectively and prioritize daily tasks. Provides input into the department resource utilization including capital and operational budget needs as appropriate. Collaborates with the leadership team to determine cost-reduction strategies. Contributes towards department financial targets on unit-based scorecard through timely documentation of care, minimizing incidental overtime, optimizing efficiency and other areas according to department specifications. (EF)

GROWTH/INNOVATION - 5%
  1. Shares knowledge with CM Representatives of payor/reimbursement practices and regulations that may impact patient's plan of care and confers with care coordinators and social workers to prioritize placement requests. (EF)
  2. Offers innovative solutions through participation in department projects and shared governance activities. Identifies opportunities to improve operational efficiencies that contribute to the success of another department. Assumes responsibility for self-growth and development by participating in in-services programs and continuing education. Completes and updates the individual development plan (IDP) on an on-going basis. (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.

Qualifications:

EDUCATION REQUIREMENTS

  • Associates degree or two additional years experience in lieu of degree

EXPERIENCE REQUIREMENTS
  • Five years experience in insurance, case management, or business office-related area, three of which must be in case management
  • Previous experience in Case Management, post-acute setting or physician practice

CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED

  • None

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.
  • Some knowledge of community resources
  • Ability to work independently while collaborating with other team members and exercise sound judgment in interactions with physicians, payors, and patients and their families
  • Adapts to multiple ongoing priorities with minimal supervision including but not limited to organizing workflows and actively participating in problem solving
  • Demonstrates ability to access information both in the department and within the hospital system to support the department and interprofessional health care team as appropriate
  • Possesses expert computer knowledge. Operates multiple computer systems including electronic health records, i.e., Epic, and Microsoft Office (Word, PowerPoint, & Excel) to maintain patient information
  • Strong knowledge of Medical Terminology
  • Excellent telephone, oral and written communication skills, time management and prioritization skills
  • Must be able to learn new skills effectively

SUPPLEMENTAL REQUIREMENTS

Work AttireYes/No
Uniform No
ScrubsNo
Business professionalYes
Other (dept. approved) No

On-Call* No (for Non-Exempt or Exempt jobs)
*Note that employees may be required to be on-call during emergencies (i.e. Disaster, Severe Weather Event, etc.) regardless of selection above. 
 
Travel**  
May require travel within Yes 
Houston Metropolitan area 

May require travel outside No
of Houston Metropolitan area 
**Travel specifications may vary by department.  

Please note any other special considerations to this job: _______________________



Company Profile:

Since its founding in 1919, Houston Methodist Hospital has earned worldwide recognition. Houston Methodist Hospital is affiliated with the Weill Medical College of Cornell University and New York-Presbyterian Hospital, one of the nation's leading centers for medical education and research. In 2020, U.S. News & World Report named Houston Methodist Hospital to its top ranked Honor Roll for the fourth time and second consecutive year. 2020 also marked the ninth year in a row Houston Methodist Hospital has been named the No. 1 hospital in Texas. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 952 operating beds, 85 operating rooms and over 8,000 employees, Houston Methodist offers complete care for patients from around the world.

The same high-quality care for which Houston Methodist is known is available at several Emergency Care Centers in Houston and the surrounding areas. These Emergency Care Centers house exam rooms, full digital radiography suite, low radiation dose 16-slice CT scan, ultrasound and a full on-site stat chemistry lab.

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