At Houston Methodist, the Case Manager (CM) Certified position is a registered nurse (RN) responsible for comprehensively planning for case management of a targeted patient population on a designated unit(s) and/or service line. This position works with the physicians and interprofessional healthcare team to facilitate and maintain compassionate, efficient quality care and achievement of desired treatment outcomes. The CM Certified position holds joint accountability with social workers 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. In addition to performing the duties of a CM, the CM Certified position helps drive change by identifying areas where performance improvement is needed (e.g., day-to-day workflow, education, process improvements, patient satisfaction).
PRIMARY JOB RESPONSIBILITIES
Job responsibilities labeled EF capture those duties that are essential functions of the job.
PEOPLE - 20%
SERVICE - 20%
QUALITY/SAFETY - 30%
FINANCE - 25%
GROWTH/INNOVATION - 5%
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.
o Bachelor’s degree or higher in nursing
o Master’s degree preferred
o Five years hospital clinical nursing experience which includes two years in case management
CERTIFICATIONS, LICENSES AND REGISTRATIONS REQUIRED
o 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
o American Nursing Credentialing Center (ANCC)-recognized certification, Case Management-related, including but not limited to Certified Case Manager (CCM), American Case Management Association - Accredited Case Manager (ACMA-ACM)
National Board for Case Management - Accredited Case Manager (NBCM-ACM)
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
o Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
o 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
o 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
o Comprehensive knowledge of Medicare, Medicaid and Managed Care requirements
o Comprehensive knowledge of community resources, health care financial and payor requirements/issues, and eligibility for state, local and federal programs
o Comprehensive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement.
o Understanding of pre-acute and post-acute venues of care and post-acute community resources
o Ability to work independently
o Strong assessment, organizational and problem-solving skill as evidenced by capacity to prioritize multiple tasks and role components
o Demonstrates critical thinking and makes decisions using evidence-based analytical approach in interactions with physicians, payors, and patients and their families
o Competent computer skills of the entire Microsoft Office Suite (Access, Excel, Outlook, PowerPoint and Word)
Work Attire Yes/No
Business professional Yes
Other (dept approved) No
On-Call* Yes, on a regular basis
*Note that employees may be required to be on-call during emergencies (i.e. Disaster, Severe Weather Event, etc.) regardless of selection above
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: __________________________
Houston Methodist The Woodlands Hospital opened in 2017 as the eighth hospital in the Houston Methodist system. This full-service, acute care hospital offers many of the same services as our flagship hospital in the Texas Medical Center. With 187 operating beds, 15 operating rooms and more than 1,800 employees, Houston Methodist The Woodlands Hospital provides comprehensive, personalized care for residents of Montgomery County and the surrounding areas.
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At Houston Methodist, the Case Manager (CM) Certified position is a registered nurse (RN) responsible for comprehensively planning for case management of a targeted patient population on a designated unit(s) and/or service line. This position works with the physicians and interprofessional healthcare team to facilitate and maintain compassionate, efficient …
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