Supplemental Case Manager

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At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community.

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.

Job Description

Minimum Qualification

Education
:
Graduate of an accredited school of professional nursing required;
Bachelors of Nursing preferred; or graduate of an accredited Masters of Social Work program (MSW);
Master’s degree preferred

Licenses/Certifications
:

• Current and valid license to practice as a Registered Nurse in the state of Texas or
• 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 into the Case Manager position

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 program 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 for pre and post acute care
• Demonstrated understanding of motivational interviewing and change management
• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their 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 multi-disciplinary care team to effect timely, appropriate patient care.
• Addresses/resolves system problems impeding diagnostic or treatment progress.
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
• Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load.
• Documents key clinical path variances and outcomes which relate to areas of direct responsibility.
• Leads the development, implementation, evaluation and revision of clinical pathways and other Case management tools as a member of the clinical resource/team.
• Acts as preceptor/mentor to new hires.
• Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
• Completes Utilization Management and Quality Screening for assigned patients.
• Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays.
• Identifies at-risk populations using approved screening tool and follows established reporting procedures.
• Monitors LOS and ancillary resource use on an ongoing basis.
• Refers cases and issues to Care Management Medical Director in compliance with Department procedures.
• Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients.
• Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.
• Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team.
• Manages all aspects of discharge planning for assigned patients.
• Meets directly with patient/family to assess needs and develop an individualized continuing care plan.
• Collaborates and communicates with multidisciplinary team in all phases of discharge planning process.
• Ensures/maintains plan consensus from patient/family, physician and payor.
• Refers appropriate cases for social work intervention based on Department criteria.
• Collaborates/communicates with external case managers.
• Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment and supplies.
• Documents relevant discharge planning information in the medical record according to Department standards.
• Facilitates transfer to other facilities as appropriate.
• Actively participates in clinical…