Supplemental Case manager

Memorialhermann; Pearland (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

Memorial Hermann in Texas seeks a Case Manager to support physicians, primary medical homes, and interdisciplinary teams in coordinating patient care across the continuum. The role focuses on utilization management, discharge planning, and timely communication with payors.

Accountable for designated patient caseload, driving performance improvement, and ensuring high-quality, cost-effective care with strong leadership and data skills.

Qualifications

• Graduate of accredited nursing school or MSW program.
• Current Texas RN or LMSW license; LCSW preferred
• Case management certification within two years of hire

Responsibilities

• Coordinates/facilitates patient care progression across the continuum.
• Works collaboratively with physicians, nursing and other care team members to ensure timely, appropriate patient care.
• Addresses/resolves system problems impeding diagnostic or treatment progress; resolves delays to discharge.
• Seeks consultation from appropriate disciplines to expedite care and discharge.
• Documents key clinical path variances and outcomes in patient records; uses pathway data for care management.
• Leads a multidisciplinary care team to ensure high quality, cost-effective care.

Skills

Interpersonal communication

Negotiation skills

Leadership

Analytical/data management

Time management

Independent work

Education

Bachelor of Nursing

MSW degree

Master's degree preferred

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 position is to support the physician, primary medical homes, and interdisciplinary teams in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance improvement in needed (e.g., day to day workflow, education, process improvements, patient satisfaction). The position is responsible for coordinating a wide range of self management support and provides information to update and maintain relevant disease registry activity. Accountable for a designated patient caseload and plans effectively in order to meet patient needs across the continuum, provide family support, manage the length of stay, and promote efficient utilization of resources.

Job Description

Minimum Qualifications

• Education : Graduate of an accredited school of professional nursing required; Bachelors of Nursing preferred; or graduate of an accredited Masters of Social Work program (MSW); 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
• Certification in Case Management required within two (2) years of hire into the Case Manager position.

Experience / Knowledge / Skills:

• Three (3) years of experience in hospital-based nursing or social work.
• Experience in utilization management, case management, discharge planning or other cost/quality management program preferred.
• 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, disease or population management and managed care reimbursement.
• Understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre and post acute care.
• Demonstrated understanding of motivational interviewing and change management.
• 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

• 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 care.
• Addresses/resolves system problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to 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; completion of treatment plan and discharge plan; modification of plan of care, as necessary, to meet the ongoing needs of the patient; communication to third party payors and other relevant information to the care team; assignment of appropriate levels of care; completion of all required documentation in TQ screens and patient records.
• Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning). Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.
• Leads