Case Manager

United Surgical Partners International, Inc; Dallas (TX); On-site; USD 54,000 - 111,000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager | Registered Nurse to enhance patient care in a dynamic surgical environment. The role involves coordinating patient care, ensuring compliance with quality standards, and advocating for patient needs. This position offers the opportunity to work closely with a multidisciplinary team, making a significant impact on patient outcomes. If you are passionate about healthcare and committed to excellence, this role provides a fulfilling career path with opportunities for professional growth in a supportive environment.

Qualifications

• Graduate of an accredited nursing program and current RN license required.
• Experience in case management and acute care is essential.

Responsibilities

• Coordinate patient care with multidisciplinary teams for optimal outcomes.
• Monitor resource utilization and ensure compliance with quality standards.

Skills

Patient Care Coordination

Utilization Management

Quality Standards Compliance

Documentation and Reporting

Patient Advocacy

Education

Graduate of an accredited school of Nursing

Current Texas RN License

Basic Life Support (BLS) certification

Certification in Case Management

Job description

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North Central Surgical Center is a highly successful, Baylor Scott & White affiliated hospital located in Dallas, TX. We partner with the very best team members and medical staff in the area. We are a surgical focused hospital that performs over 12,000 procedures per year.

FACTS ABOUT NORTH CENTRAL: Opened in 2005, 14 Operating Rooms and 30 Medical/Surgical Patient Rooms. We are conveniently Located at Walnut Hill & 75 in the prestigious NorthPark area Specialties include: Orthopedics, Spine, General Surgery, Pain Management, Urology, GI/Endoscopy, Plastic, and Podiatry surgeries. Managed by United Surgical Partners International & Joint Commission Accredited

Under the direction of the Chief Financial Officer, the Case Manager is responsible for facilitating patient progression through the continuum of care, from pre-admission through discharge. This role provides feedback to payors regarding clinical status, secures authorization for additional days of stay, and monitors quality standards in alignment with the hospital’s Performance Improvement Plan and Medical Staff Quality Indicators. The Case Manager assesses discharge planning needs, monitors resource utilization, and addresses psychosocial and educational needs to ensure optimal patient outcomes. Additionally, this position assists in data collection for quality trending, performs infection control surveillance, and serves as a patient advocate, helping to resolve care-related concerns effectively and compassionately.

Principle Duties and Responsibilities:

Patient Care Coordination:

• Coordinate with multidisciplinary teams to ensure continuity and effectiveness of patient care throughout the healthcare continuum.
• Partner with physicians and their offices to ensure proper patient status and facilitate appropriate aftercare upon discharge.
• Serve as a patient advocate, addressing and resolving care-related concerns to support patient satisfaction and quality outcomes.
  
  

Utilization Management:

• Work in collaboration with the Utilization Management Committee, assisting with preparation for quarterly Utilization Management Committee Meetings.
• Review medical records to evaluate the appropriateness of care and summarize findings for presentation to the UM Committee.
• Communicate with insurance companies, Medicare, and other payors to ensure timely and appropriate payment for services rendered.
• Monitor resource consumption and utilization to support cost-effective care without compromising quality.
  
  

Quality Standards and Performance Improvement:

• Ensure compliance with quality standards as determined by the Performance Improvement Plan and Medical Staff Quality Indicators.
• Contribute to infection control surveillance and assist in data aggregation for quality trending and reporting.
• Support institutional goals and objectives, serving as a resource to Senior Management and actively participating in initiatives that enhance quality care.
  
  

Documentation and Reporting:

• Maintain thorough documentation for Utilization Management, including detailed records of interactions with payors, patients, and interdisciplinary team members.
• Ensure accuracy and completeness of patient records in coordination with the business office, CFO, and other stakeholders.
• Monitor and report on physician and hospital quality metrics, tracking the effectiveness of care and utilization management practices.
  
  

Professional Development:

• Pursue ongoing professional growth opportunities and maintain required certifications, including RN licensure and BLS.
• Participate in the Utilization Review Committee and relevant hospital training sessions.
• Stay current with industry practices and standards to continuously improve case management effectiveness.
  
  

Required Skills:

Education

• Graduate of an accredited school of Nursing, required
  
  

Licensure/Certification

• Current Texas RN License.
• Current Basic Life Support (BLS) certification accredited by American Heart Association (AHA) required.
• Certification in Case Management, preferred.
  
  

Specific Job Experience

• Previous experience in case management, with acute care experience

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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