Case Manager - PRN

At Houston Methodist the Case Manager PRN(CM) position is a licensed registered nurse (RN) whocomprehensively plans for case management of a target patientpopulation on a designated unit(s).

This position works with thephysicians and interprofessional health care team to facilitate andmaintain compassionate efficient quality care and achievement ofdesired treatment outcomes.

The CM PRN holds joint accountabilitywith social worker for discharge planning and continuity of careand assures that admission and continued stay are medicallynecessary and communicates clinical information to payors to ensurereimbursement.

The CM PRN helps drive change by identifying areaswhere performance improvement is needed (e.g. daytoday workfloweducation process improvements patientsatisfaction).

PEOPLE ESSENTIALFUNCTIONS

Collaborates withthe physician and all members of the interprofessional health careteam to facilitate care for designated case load;

monitors thepatients progress intervening as needed to ensure that the plan ofcare and services provided are patientfocused high qualityefficient and costeffective; facilitates timely :

• completion and reporting of diagnostic testing;
• completion of treatment plan and discharge plan;
• modification of plan of care as necessary to meet the ongoing needsof the patient;
• assignment of appropriate levels ofcare;

completion of all required documentation in EPICand MIDAS

Serves as apreceptor as appropriate and implements staff education specific topatient populations and unit processes; coaches and mentors otherstaff and students.

Serves a resource for case management andsocial work resources and needs for the department and thehospital.

SERVICE ESSENTIALFUNCTIONS

Performs reviewfor medical necessity of admission continued stay and resource useappropriate level of care and program compliance.

Identifies whenservices no longer meet InterQual / Millman l criteria initiatesdiscussion with attending physicians coordinates with the externalcase manager to facilitate discharge planning seeks assistance fromthe physician advisor if needed and informs management of thepossible need for issuing Medicare Hospital Initiated Notice ofNoncoverage.

Appliesapproved utilization criteria to monitor appropriateness ofadmissions level of care resource utilization and continued stay.

Reviews level of care denials to identify trends and collaboratewith team to recommend opportunities for processimprovement.

QUALITY / SAFETYESSENTIALFUNCTIONS

• Documentsassessment and interventions efficiently andeffectively.
• Plans forroutine / difficult discharge and anticipates / prevents and managesemergent situations. Specific focus given to discharge plan andelimination ofbarriers.
• Performspostdischarge review by analyzing the inpatient record to ensurethat compliance with quality indicators are met.

Intervenes andtakes appropriate action to foster realtime compliance with CMSguidelines and other performance measures associated withcertification programs and other regulatory national regional orlocally sponsored quality programs.

Provides reports as needed toappropriate parties showing :

compliance with establishedgovernmental and / or institutional rules and regulations

analysis of problematic areas and

actions taken toimprovecompliance

• Conducts chartaudits and performs peertopeer evaluations for continuous qualityimprovement.
• Identifiesopportunities to improve patient satisfaction with focus ondischarge domain and collaborates with unit leadership to implementevidencebased patient engagementstrategies.

FINANCEESSENTIAL FUNCTIONS

MonitorsLength of Stay (LOS) for case load on an ongoing basis. Identifiespopulation and / or servicespecific trends impacting LOS andaddresses / resolves problems impeding treatment progress.

Proactively takes action to achieve continuous improvement andexpedite care / facilitate discharge. Contributes to meetingdepartmental financial target onscorecard

• Manages allpatients in Observation Status daily informing physicians of timelydisposition options to assure maximum benefits for patients andreimbursement for thehospital.
• Securesreimbursement for hospital services by communicating medicalinformation required by all external review entities managed carecontracts insurers fiscal intermediaries and state and federalagencies.

Responds to requests for information monitors covereddays and initiates review to assure that all days are covered andreimbursable.

GROWTH / INNOVATIONESSENTIAL FUNCTIONS

• Provides educationto unitbased physicians nurses and other healthcare providers onany case managementtopics.
• Identifiesopportunity for practice changes. Offers innovative solutionsthrough evidencebased practice / performance improvement projects andshared governanceactivities.
• Identifies andpresents areas for innovation efficiency and improvement in casemanagement or department operations using evidencebased practiceliterature.

Completes and updates the individual development plan(IDP) on an ongoing basis.

This jobdescription is not intended to be allinclusive; the employee willalso perform other reasonably related business / job duties asassigned.

Houston Methodist reserves the right to revise job dutiesand responsibilities as the needarises.

EDUCATION

Graduateof education program approved by the credentialing body for therequired credential(s) indicated below in the Certificates Licensesand Registrationssection.

WORKEXPERIENCE

Three (3) yearshospital clinical nursing experience which includes two (2) yearsin casemanagement

LICENSES ANDCERTIFICATIONS REQUIRED

• RNRegistered Nurse Texas State Licensure and / or Compact StateLicensure within 90 days or
• RNTemp RegisteredNurse Temporary State Licensure within 90 days

KNOWLEDGE SKILLS ANDABILITIES

• Demonstrates theskills and competencies necessary to safely perform the assignedjob determined through ongoing skills competency assessments andperformanceevaluations.
• Sufficientproficiency in speaking reading and writing the English languagenecessary to perform the essential functions of this job especiallywith regard to activities impacting patient or employee safety orsecurity.
• Ability toeffectively communicate with patients physicians family members andcoworkers in a manner consistent with a customer service focus andapplication of positive languageprinciples.
• Strongassessment organizational and problemsolving skill as evidenced bycapacity to prioritize multiple tasks and rolecomponents
• Knowledge ofMedicare Medicaid and Managed Carerequirements
• Comprehensiveknowledge of community resources health care financial and payerrequirements / issues and eligibility for state local and federalprograms
• Comprehensiveknowledge of discharge planning utilization management casemanagement performance improvement and managed carereimbursement.
• Understandingof preacute and postacute venues of care and postacute communityresources.
• Ability to workindependently
• Strongassessment organizational and problemsolving skill as evidenced bycapacity to prioritize multiple tasks and rolecomponents
• Demonstratescritical thinking and makes decisions using evidencebasedanalytical approach in interactions with physicians payors andpatients and theirfamilies
• Well versed incomputer skills of the entire Microsoft Office Suite (Access ExcelOutlook PowerPoint andWord)

SUPPLEMENTALREQUIREMENTS

WORKATTIRE

• UniformNo
• Scrubs No
• Businessprofessional Yes
• Other (department approved)No

ONCALL*

• Notethat employees may be required to be oncall during emergencies (ie.DIsaster Severe Weather Events etc) regardless of selectionbelow.
• On Call*Yes

TRAVEL

Travelspecifications may vary bydepartment

• May requiretravel within the Houston Metropolitan areaYes
• May require travel outside HoustonMetropolitan areaNo

CompanyProfile :

Houston Methodist TheWoodlands Hospital opened in June 2017 as the eighth hospital inthe Houston Methodist system. This 267bed 725000squarefootfullservice acutecare hospital offers many of the same services asour flagship hospital in the Texas Medical Center.

• Also on thebeautiful hospital campus located at the intersection of Interstate45 and Texas State Highway 242 are two medical office buildingswhich include a Breast Care Center;
• Cancer Center; infusion center;heart and vascular services; neurology; orthopedics and sportsmedicine; rehabilitation services;

wellness services; an outpatientlaboratory; and several other multispecialty physician practices.In January 2022 Houston Methodist The Woodlands opened HealingTower a $250 million expansion project that added 106 beds focusedon medicalsurgical and womens services and provided nine operatingrooms.

The project also included the expansion of the endoscopycenter emergency department and diagnostic imaging department withan enhanced neurodiagnostic and interventionalcenter.

Houston Methodist is an equal opportunityemployer inclusive of women minorities disabled persons andveterans.

Equal EmploymentOpportunity

Houston Methodist isan Equal Opportunity Employer.

Equal employmentopportunity is a sound and just concept to which Houston Methodistis firmly bound. Houston Methodist will not engage indiscrimination against or harassment of any person employed orseeking employment with Houston Methodist on the basis of racecolor religion sex sexual orientation gender identity nationalorigin age disability status as a protected veteran or othercharacteristics protected by law.

VEVRAA Federal Contractorpriority referral Protected Veteransrequested.