At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN) responsible for comprehensively planning for case management, which includes care transitions and discharge planning of a targeted patient population on a designated unit(s) and/or service lines. 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 position holds joint accountability with the 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 - 20%
SERVICE - 25%
QUALITY/SAFETY - 20%
FINANCE - 25%
GROWTH/INNOVATION - 10%
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 Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section.
o Bachelor’s degree preferred
o Three years hospital nursing clinical experience
o Case management experience preferred
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.
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 Knowledge of Medicare, Medicaid and Managed Care requirements
o Progressive knowledge of community resources, health care financial and payor requirements/issues, and eligibility for state, local and federal programs
o Progressive 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 and exercise sound judgment in interactions with physicians, payors, and patients and their families
o Well versed in computer skills of the entire Microsoft Office Suite (Excel, Outlook, PowerPoint and Word)
o Strong assessment, organizational and problem-solving skill
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: __________________________
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 2022, U.S. News & World Report named Houston Methodist Hospital to its prestigious Honor Roll for the sixth time. Also, in this year’s rankings, Houston Methodist Hospital was named the No. 1 hospital in Texas for the 11th year in a row. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 946 operating beds, 85 operating rooms and nearly 8,500 employees, Houston Methodist Hospital offers complete care for patients from around the world.
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