RN Case Management Manager | Lead Patient Care & Care Transitions

thestaffpad; Hamilton (TX); On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

Paid Time Off

Health Insurance

Retirement Plan

Direct Deposit

Education Reimbursement

Fitness Center Membership

Job summary

The Staff Pad partners with a healthcare organization in Hamilton, TX to recruit an experienced Case Management Manager. You will lead the Case Management team to coordinate patient care from admission through discharge, collaborate with physicians and nursing staff, and remove barriers to timely discharge while promoting safe, cost-effective care.

Ideal candidates will be an RN with Texas licensure, 5+ years of bedside and leadership experience, and a commitment to patient advocacy, quality,

Qualifications

• RN license in Texas.
• Graduate of an accredited School of Nursing.
• Current CPR, BLS certification; ACLS preferred.
• 5+ years of Registered Nurse experience.
• Case Management leadership experience preferred.
• Knowledge of utilization management, discharge planning, and regulatory requirements.

Responsibilities

• Conduct discharge assessments on admission and develop timely discharge plans.
• Perform daily patient assessments, monitor, evaluate & document patient progress.
• Coordinate post-hospital care & discharge to home or other care settings.
• Educate patients and families; liaison among patients, families, physicians and care team.
• Document discharge services accurately and timely per hospital policy.
• Maintain individualized patient care plans and update them as status changes.
• Review denials, identify appeal needs, and ensure appropriate appeal completion.

Skills

Utilization management

Discharge planning

Regulatory compliance

Leadership

Communication

Education

Bachelor of Science in Nursing

Job description

The Staff Pad is proud to partner with a respected healthcare organization in Hamilton, TX to recruit an experienced Case Management Manager who is passionate about improving patient outcomes, leading high-performing teams, and ensuring safe, efficient transitions of care. The Case Management Manager leads and supports the Case Management team in coordinating patient care from admission through discharge. This role collaborates closely with physicians, nursing staff, and interdisciplinary teams to remove barriers to timely discharge, improve patient outcomes, ensure regulatory compliance, and promote cost-effective care while maintaining the highest standards of patient advocacy

What You’ll Do Key Responsibilities

• Conduct discharge assessments on admission & develop timely, appropriate discharge plans
• Perform daily patient assessments, monitor, evaluate & document patient progress
• Coordinate post-hospital care & coordinate discharge to home and other care settings
• Provide, document, and coordinate patient and family education; serve as liaison among patients, families, physicians, and the care team
• Document discharge services accurately and timely in accordance with hospital policy
• Maintain individualized patient care plans and update them based on changes in patient status
• Review denials, identify appeal needs, and ensure appropriate appeal completion
• Review continued stay, medical necessity, medical reports and treatment plans
• Facilitate access to financial assistance, advance directives, legal aid, education and medication assistance programs
• Coordinate patient care and rehabilitation using consultation findings and social work expertise
• Partner with Quality Improvement to enhance patient safety, establish goals, and submit monthly quality reports
• Review payer-requested charts and communicate clinical information to payers
• Maintain referral source database & refer patients, families to community resources
• Identify barriers to patient progress & perform social work duties as needed
• Document ongoing physiological, psychosocial assessments, patient and family education and responses & interdisciplinary care plan recommendations
• Validate, transcribe, and co-sign physician orders; report patient progress, and advise physicians and departments on utilization management regulations
• Perform utilization reviews in compliance with state regulations and evolving utilization management regulations
• Monitor daily case management needs & maintain collaborative staff relationships
• Communicate discharge plans with physicians and complete follow-up calls within three days of discharge

Additional Responsibilities

• Assist with coordinating quarterly utilization review committee activities and updating policies and procedures
• Perform registered nurse duties in accordance with the RN job description
• Maintain confidentiality and HIPAA compliance when handling sensitive information
• Adhere to organizational behavioral standards personnel policies and customer service expectations
• Perform other duties as assigned

What We Are Looking For

• Graduate of an accredited School of Nursing
• RN license in the State of Texas
• Current CPR, BLS certification; ACLS preferred
• 5+ years of Registered Nurse experience
• Case Management leadership experience preferred
• Knowledge of utilization management, discharge planning, and regulatory requirements

Additional Requirements

• Compassionate and patient-focused leadership
• Excellent communication, relationship-building, clinical judgement and problem-solving skills
• Commitment to quality, safety, and continuous improvement
• Ability to multitask and perform in a fast-paced environment
• Ability to stand, walk, bend, lift up-to 50 pounds, and assist patients as needed

What You Can Expect Benefits

• Paid Time Off & Holidays
• Health & Supplemental Insurance
• Direct Deposit
• Fitness Center Membership
• Education Reimbursement
• Retirement Plan