Case Management RN Manager

HCA Houston Healthcare; Houston (TX); On-site; USD 110,000 - 140,000; Full time

Benefits offered by this job

Medical coverage

401(k) match

Paid time off

Job summary

HCA Houston Healthcare Northwest is seeking a Case Management RN Manager to oversee the Case Management Department, coordinating utilization management, transition planning, and education for clinicians and staff. The role ensures efficient throughput, compliance with CMS and TJC standards, and supports appropriate reimbursement for services delivered.

The position reports to the Director of Case Management and collaborates with physicians, patients, families, and caregivers to optimize hospital

Qualifications

• RN license required.
• Bachelor's degree required; Master's preferred.
• 1 year acute hospital case management leadership experience preferred. ACM preferred. McKesson InterQual experience preferred.

Responsibilities

• Oversee Case Management Department activities.
• Coordinate, monitor, and evaluate case management processes.
• Support utilization performance improvement and appropriate reimbursement for services.

Skills

RN license

Leadership experience

ACM

InterQual experience

Education

Bachelor's degree

Master's degree

Tools

McKesson InterQual

Job description

Introduction Managers thrive with us! HCA Healthcare is one of the nation’s leading providers of healthcare services, comprising of over 180 hospitals and about 2,000 sites of care in 21 states and the United Kingdom. We are looking for a Case Management RN Manager for our HCA Houston Healthcare Northwest team where excellence creates excellence.

Benefits

HCA Houston Healthcare Northwest offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
• Free counseling services and resources for emotional, physical and financial wellbeing
• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
• Employee Stock Purchase Plan with 10% off HCA Healthcare stock
• Family support through fertility and family building benefits with Progyny and adoption assistance.
• Referral services for child, elder and pet care, home and auto repair, event planning and more
• Consumer discounts through Abenity and Consumer Discounts
• Retirement readiness, rollover assistance services and preferred banking partnerships
• Education assistance (tuition, student loan, certification support, dependent scholarships)
• Colleague recognition program
• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn More About Employee Benefits

Note: Eligibility for benefits may vary by location.

HCA Healthcare has expanded our influence across the healthcare industry by investing $3.5 billion in capital improvements in recent years. Do you want to be an influencer in healthcare?

Job Summary And Qualifications

The manager of case management reports directly to the Director of Case Management and provides oversight to the Case management team (as directed by the DCM). She/he is co-responsible for coordinating, monitoring, executing and evaluating Case Management Department activities. The individual in this position is accountable for assisting hospital utilization performance improvement in order to promote effective utilization of hospital resources, ensure processes support appropriate reimbursement for services rendered, support efficient patient throughput, and ensure compliance with all state and federal regulations related to case management services.

This position integrates national standards for case management scope of services including:

• Utilization Management supporting medical necessity and denial prevention
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
• Compliance with state and federal regulatory requirements, TJC accreditation standards and HCA policy
• Education provided to physicians, patients, families and caregivers
• Manage department operations to assure effective throughput and reimbursement for services provided
• Ensure medical necessity review processes are completed accurately and in compliance with CMS regulations and HCA policy
• Ensure timely and effective patient transition and planning to support efficient patient throughput
• Implement and monitor processes to prevent payer disputes
• Develop and provide physician education and feedback on hospital utilization
• Ensure compliance with state and federal regulations and TJC accreditation standards and other duties as assigned

What qualifications you will need:

• (RN) Registered Nurse license required
• Bachelors Degree required, or Masters Degree preferred
• One year acute hospital case management leadership experience preferred. Accredited Case Manager (ACM) preferred. McKesson InterQual® experience preferred. Two years acute hospital case management experience preferred.

HCA Houston Healthcare Northwest is a 415+ bed acute care hospital that has been serving the north Houston communities for more than 40 years, providing a wide range of medical services including cardiology, maternity care, Level III NICU, pediatrics, bariatrics and neurology. We comprehensively serve our community by employing expert physicians, specialists, nurses and support staff who work together as a unified team to offer a range of diagnostic treatment and support services. From our 24-hour emergency department with Level II Trauma capabilities, to women’s services, to cardiology, we are dedicated to improving the health of our community by delivering exceptional, personalized healthcare. We are members of HCA Houston Healthcare, the most comprehensive family of hospitals in the region and part of the leading provider of healthcare in the country, HCA Healthcare. Together we are stronger, smarter and more accessible in providing the patient-centered care you need close to home.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.