Overview Be among the first 25 applicants. At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
The purpose of the Case Manager position is to support the physician, primary medical homes, and interdisciplinary teams. Facilitates patient care with the objective of enhancing clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. The Case Manager helps drive change by identifying areas for performance improvement and coordinates self-management support and disease registry activity. The position is responsible for coordinating a wide range of activities for a designated patient caseload and planning across the continuum to meet patient needs, support families, manage length of stay, and promote efficient utilization of resources.
Responsibilities Coordinate and facilitate patient care progression throughout the continuum.
Collaborate with physicians, nursing staff and the multidisciplinary care team to ensure timely, appropriate patient care.
Address and resolve system problems impeding diagnostic or treatment progress; identify and resolve discharge delays/obstacles.
Seek consultation from appropriate disciplines to expedite care and discharge; use conflict resolution skills as needed.
Monitor patient progress and ensure the plan of care and services are patient-focused, high quality, efficient, and cost effective.
Complete and report diagnostic testing, treatment plans, and discharge plans; communicate with payors and the care team as needed.
Assign appropriate levels of care; ensure all documentation is completed in required systems and records.
Collaborate with medical staff, nursing staff, and ancillary staff to remove barriers to efficient care in the appropriate setting.
Perform Utilization Management and Quality Screening for assigned patients; apply clinical criteria to monitor admissions and stays.
Identify at-risk populations, monitor LOS and resource use, and participate in performance improvement activities.
Refer cases for social work intervention as indicated; coordinate with external case managers when needed.
Manage discharge planning for assigned patients; conduct patient/family meetings to develop continuing care plans in collaboration with the physician.
Communicate with Resource Center for home health, hospice, and medical equipment referrals; document discharge planning information per department standards.
Participate in performance improvement activities and use data to drive decisions and improvements in case management, including fiscal, clinical and patient satisfaction metrics.
Mentor new hires and assist in orienting staff; promote professional growth and adherence to policies and standards.
Adhere to Memorial Hermann policies, procedures, and standards within budgetary specifications; maintain time and resource management and quality of service.
Demonstrate commitment to compassionate, personalized care for every member of the community.
Other duties as assigned.
Qualifications Education : Graduate of an accredited nursing program required; Bachelor of Nursing preferred, or graduate of an accredited Master’s of Social Work program.
Licenses/Certifications :
Current and valid licensed Registered Nurse in Texas, or Master Social Worker (LMSW) in Texas required; LCSW preferred. Certification in Case Management required within two (2) years of hire.
Experience / Knowledge / Skills :
Three (3) years of nursing or social work experience in acute hospital-based setting preferred, or three (3) years in a comparable clinical setting (e.g., ambulatory surgery center, infusion/dialysis clinic, FQHC, skilled nursing facility, wound clinic).
Experience in utilization management, case management, discharge planning or other cost/quality management programs preferred.
Excellent interpersonal communication and negotiation skills; demonstrated leadership and strong analytical, data management, and PC skills.
Knowledge of discharge planning, utilization management, case management, performance improvement, disease/population management and managed care reimbursement.
Understanding of pre-acute and post-acute care venues and community resources; knowledge of motivational interviewing and change management.
Strong organizational and time management skills; ability to prioritize multiple tasks; ability to work independently and exercise sound judgment with physicians, payors, and patients/families.
Effective oral and written communication skills.
Seniority level Mid-Senior level
Employment type Full-time
Job function Other
Industries: Hospitals and Health Care