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Job Summary
The purpose of the Case Manager position is to support the physician, primary medical homes, and interdisciplinary teams in facilitating patient care, with the underlying objective of enhancing the quality of 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. In addition, the Case Manager helps drive change by identifying areas where performance improvement is needed (e.g., day‑to‑day workflow, education, process improvements, patient satisfaction). The position is responsible for coordinating a wide range of self‑management support and provides information to update and maintain relevant disease registry activity. Accountable for a designated patient caseload and plans effectively in order to meet patient needs across the continuum, provide family support, manage the length of stay, and promote efficient utilization of resources.
Job Description
As a Supplemental Case Manager, you will coordinate and facilitate patient care progression throughout the continuum, collaborate with physicians, nursing, and other members of the multidisciplinary care team to ensure timely and appropriate patient care, resolve system problems, and proactively manage discharge planning. You will use your knowledge of utilization management and quality improvement to monitor appropriateness of admissions and ongoing stays, identify at‑risk populations, and implement data‑driven improvements. Your responsibilities also include pre‑educating new hires, participating in clinical performance improvement activities, and maintaining documentation in accordance with department standards.
Minimum Qualification
Education: Graduate of an accredited school of professional nursing required; Bachelors of Nursing preferred; Graduate of an accredited Masters of Social Work program (MSW) required; Master’s degree preferred.
Licenses/Certifications:
Current and valid license to practice as a Registered Nurse in the state of Texas.
Current and valid license as a Master Social Worker (LMSW) in the state of Texas required; LCSW preferred.
Certification in Case Management required within two (2) years of hire.
Experience / Knowledge / Skills
Three (3) years of experience in hospital‑based nursing or social work.
Experience in utilization management, case management, discharge planning, or other cost/quality management programs preferred.
Excellent interpersonal communication and negotiation skills.
Demonstrated leadership skills.
Strong analytical, data management, and PC skills.
Current working knowledge of discharge planning, utilization management, case management, performance improvement, disease or population management, and managed care reimbursement.
Understanding of pre‑acute and post‑acute venues of care and post‑acute community resources, physician office routines, and transitional procedures.
Demonstrated understanding of motivational interviewing and change management.
Strong organizational and time‑management skills, evidenced by capacity to prioritize multiple tasks.
Ability to work independently and exercise sound judgment in interactions with physicians, payors, patients, and families.
Effective oral and written communication skills.
Principal Accountabilities
Coordinates/facilitates patient care progression throughout the continuum.
Works collaboratively and maintains active communication with physicians, nursing, and other members of the multidisciplinary care team to facilitate timely, appropriate patient care.
Addresses and resolves system problems impeding diagnostic or treatment progress; proactively identifies and resolves delays and obstacles to discharge.
Seeks consultation from appropriate disciplines/departments to expedite care and facilitate discharge.
Utilizes advanced conflict resolution skills as needed to ensure timely resolution of issues.
Monitors patient progress and intervenes as necessary to ensure that the plan of care is patient‑focused, high‑quality, efficient, and cost‑effective.
Facilitates completion and reporting of diagnostic testing, treatment and discharge plans, modifications to plan of care, and communication to third‑party payors.
Assigns appropriate levels of care and completes documentation in TQ screens and patient records.
Documents key clinical path variances and outcomes, using pathway data to ensure effective patient management.
Leads development, implementation, evaluation, and revision of clinical pathways and case‑management tools; assists in compiling physician profile data on LOS, resource utilization, costs, readmissions, and quality indicators.
Acts as preceptor/mentor to new hires and assists in orientation planning.
Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient care delivery.
Completes Utilization Management and Quality Screening for assigned patients.
Monitors LOS and ancillary resource use continuously, taking actions for continuous improvement.
Communicates with the Resource Center to facilitate reimbursement certification for assigned patients and resolves payor issues.
Ensures comprehensive communication of the plan of care to the patient/family and the healthcare team for continuity of care.
Manages all aspects of discharge planning, including assessment of needs, development of individualized care plans, and collaboration with the multidisciplinary team.
Acts as a liaison for external case managers and facilitates necessary referrals.
Participates in clinical performance improvement activities and assists in financial reporting of key indicators such as LOS, cost per case, and readmission rates.
Uses data to drive decisions and implement performance improvement strategies related to case management for assigned patients.
Promotes safe and efficient care to patients, staff, and visitors, adhering to all institutional policies and standards.
Supports professional growth, mandatory continuing education, and serves as a resource to less experienced staff.
Demonstrates commitment to caring for every member of the community; models Memorial Hermann’s service standards through safe, caring, personalized, and efficient care.