Follow Us On LinkedIn (Link opens in a new window)
Case Manager I - Full Time - TMC - LTAC
Job Ref # 16993
SHARE THIS
Location:
Houston Methodist Hospital
6565 Fannin St
Houston, TX 77030

Category: Case Management/Social Work

Job Type: Full-Time

Posted Date: Oct. 15, 2021

JOB SUMMARY
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.

Requirements:

PRIMARY JOB RESPONSIBILITIES
Job responsibilities labeled EF capture those duties that are essential functions of the job.

PEOPLE - 15%

  1. 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)
  2. 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%
  1. Assesses all patients timely and thoroughly. Participates in daily Care Coordination Rounds, and identifies, communicates barriers to efficient patient throughput. (EF)
  2. 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)
  3. 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)
  4. Supports patients and families in preventing/resolving clinical or ethical issues. (EF)

QUALITY/SAFETY - 25 %
  1. 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)
  2. Plans for routine discharge and elevates emergent situations. (EF)
  3. 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)
  4. Focuses on discharge domain by contributing to departmental targets for quality and safety measures on scorecard. (EF)

FINANCE - 25%
  1. Contributes to meeting departmental financial target on scorecard, with focus on length of stay. (EF)
  2. 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)
  3. Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay (EF)

GROWTH/INNOVATION - 10%
  1. Identifies and presents areas for improvement in patient care or department operations and offers solutions by participating in unit projects and activities. (EF)
  2. 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.

Qualifications:

EDUCATION REQUIREMENTS

  • 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

EXPERIENCE REQUIREMENTS
  • 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

SUPPLEMENTAL REQUIREMENTS

Work AttireYes/No
Uniform No
ScrubsNo
Business professionalYes
Other (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.

Travel**
May require travel within Yes
Houston Metropolitan area 

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.

GO
Houston Methodist Included On List Of Best Places To Work In 2022
Houston Methodist Named a Best Place to Work in 2022. Through voluntary and anonymous feedback shared on Glassdoor, Houston Methodist is proud to announce our inclusion on their list of the Best Places to Work in 2022. The feedback provided by our employees aligns with our I CARE values …
Houston Methodist Named Best Employer
Houston Methodist is excited to announce that Forbes and Statista have again named us a Top Employer in Texas. This is their third annual list highlighting noteworthy employers based on surveys from 80,000 Americans working for businesses with at least 500 employees. We at Houston Methodist are honored being featured …
Houston Methodist Hospital Named a ‘World’s Best Smart Hospital’
Houston Methodist is proud to announce that Houston Methodist Hospital is named a ‘World’s Best Smart Hospital 2021’. Newsweek and Statista partnered to develop a list of hospitals deemed best for integrating new technologies and data-driven opportunities as part of their delivery of health care. At Houston Methodist, we strive …

VISIT THE DAILY DOSE HOMEPAGE FOR MORE ARTICLES >>

May require travel outside No
of Houston Metropolitan area 
**Travel specifications may vary by department.  
Please note any other special considerations to this job: _______________________