At Houston Methodist, the Case Manager (CM) Certified position is 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 line. In addition to performing the duties of a CM, this position helps drive change by identifying areas where performance improvement is needed, e.g., day-to-day workflow, education, process improvements, patient satisfaction. The CM Certified position is accountable for discharge planning and continuity of care. This position works with patients, families, physicians, and interprofessional healthcare teams to facilitate and maintain compassionate, efficient quality care and achievement of desired treatment outcomes. The CM Certified position will serve as preceptor for other case managers and social workers.
FLSA STATUS
Exempt
QUALIFICATIONS
EDUCATION Bachelor’s degree or higher from an accredited school of Nursing
Master’s degree preferred
EXPERIENCE Five years of hospital clinical nursing experience, which includes three years in case management
LICENSES AND CERTIFICATIONS
Required RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency) and
Magnet ANCC-recognized Case Management certification: ACHPN-HPCC or CCM or CMC or ACM-NBCM or CDCES or CHPN-HPCC or CMGT-BC or CM-ABOHN or CMCN or ANCC-NCM or CMC-NACCM or COHN or COHN/CM or CPHRM
KNOWLEDGE AND ABILITIES Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing 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
Comprehensive knowledge of Medicare, Medicaid and Managed Care requirements
Comprehensive knowledge of community resources, health care financial and payor requirements/issues, and eligibility for state, local and federal programs
Comprehensive 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
Strong assessment, organizational and problem-solving skill as evidenced by capacity to prioritize multiple tasks and role components
Demonstrates critical thinking and makes decisions using evidence-based analytical approach in interactions with physicians, payors, and patients and their families
Competent computer skills of the entire Microsoft Office Suite (Access, Excel, Outlook, PowerPoint and Word)
ESSENTIAL FUNCTIONS
PEOPLE ESSENTIAL FUNCTIONS Collaborates with the physician and all members of the multidisciplinary healthcare team to facilitate care for designated assignment; monitors the patient’s medical progress, intervening as needed to ensure that the plan of care and services provided are patient-focused, high-quality, efficient, and cost-effective.
Independently and effectively communicates with physicians, multidisciplinary care team, patients, families and payers to ensure safe and timely transitions of care. Proactively seeks assistance from physician advisor, as needed. Facilitates clinical conversations with payers to expedite authorization for appropriate post-acute placement based on the clinical condition of the patient.
Serves as a preceptor and implements staff education specific to patient populations and department processes, coaches and mentors’ other staff and nursing students. Serves an expert case…