Sr Case Manager/Department Educator

Memorialhermann; United States; On-site; USD 85,000 - 120,000; Full time

Job summary

Memorial Hermann is seeking a Senior Case Manager to optimize clinical outcomes and efficient resource use within a defined patient population.

You will lead discharge planning efforts, collaborate with physicians and care teams, and drive improvements in length of stay and reimbursement in alignment with organizational goals.

Qualifications

• BSN or MSW required; Master’s degree preferred.
• Current Texas RN license or LMSW in Texas; Case Manager Certification required.
• 3+ years in utilization/case management or discharge planning.
• Experience in hospital-based nursing or social work.

Responsibilities

• Oversees management of high-risk patient populations across the care continuum.
• Collaborates with physicians and multidisciplinary team to develop pathways and CMS metrics.
• Facilitates timely discharge planning and coordination of care across pre- and post-acute settings.
• Analyzes variances and identifies opportunities for process improvement.

Skills

Interpersonal communication

Negotiation skills

Leadership

Analytical skills

Discharge planning

Utilization management

Cost management

Time management

Communication skills

Education

BSN

MSW

Master's degree preferred

Tools

EMR systems

Job description

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

The purpose of the Case Manager, Sr. position is to work within a defined patient population to promote the achievement of optimal clinical and resource outcomes. Responsible for facilitating appropriate lengths of stay and reimbursement for all hospital admissions in accordance with its goals and objectives. Acts as the key information and education resource for the interdisciplinary team. Works to develop organization-wide approaches to problem solving. Analyzes current systems and variances to identify opportunities for improvement. Works to promote quality of care through collaboration with all service team members, patients and families. Works with the leadership team to align the goals and visions. Accountable for a designated patient caseload that is considered more complex and resource intensive. Plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Job Description

Minimum Qualifications

• Education : Bachelors of Science in Nursing (BSN) or Social Work (MSW) required; Master's degree preferred.
• Licenses/Certifications : Current and valid license to practice as a Registered Nurse in the state of Texas or Current and valid license as a Master Social Worker (LMSW) in the state of Texas required, LCSW preferred. Case Manager Certification required.

Experience / Knowledge / Skills :

• Three (3) years experience in utilization management, case management, discharge planning or other cost/quality management program.
• Minimum three (3) years of experience in hospital-based nursing or social work.
• Excellent interpersonal communication and negotiation skills.
• Demonstrated leadership skills.
• Strong analytical, data management and PC skills.
• Current working 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.
• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families.
• Effective oral and written communication skills.

Principal Accountabilities

Oversees the management of specific patient populations across the continuum focusing on high-risk, high-cost patients. Serves as a resource to the multidisciplinary team for the management of complex patients. Works with physician leadership and the multidisciplinary team for defined patient populations to develop clinical pathways, continuum care management programs, measurement and feedback of performance indicators for cost, quality and service and patient satisfaction. Serves as the primary information resource for case management staff, payors, physicians, other healthcare team members and customers (skill areas include: regulatory requirements, pathway development/implementation, ethics/healthcare law, clinical skill, etc.). Facilitates learning experiences of healthcare team members, conducts in-services, and/or serves as a resource for pathways. Participates in teaching CM Modules. Assumes delegated activities from the Director as needed. Coordinates/facilitates patient care progression throughout the continuum. Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management. Proactively identifies/resolves issues impeding diagnostic, treatment progress and discharge. Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge. Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues. Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load; monitors the patient's progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective; facilitates the following on a timely basis: completion and reporting diagnostic testing, treatment plan and discharge plan; modification of plan of care, as necessary, to meet the ongoing needs of the patient; communication to th