Case Manager - PRN
Company: Houston Methodist The Woodlands Hospital
Location: New Waverly
Posted on: May 6, 2024
Job Description:
At Houston Methodist, the Case Manager PRN (CM) position is a
licensed registered nurse (RN) who comprehensively plans for case
management of a target patient population on a designated unit(s).
This position works with the physicians and interprofessional
health care team to facilitate and maintain compassionate,
efficient quality care and achievement of desired treatment
outcomes. The CM PRN holds joint accountability with social worker
for discharge planning and continuity of care and assures that
admission and continued stay are medically necessary and
communicates clinical information to payors to ensure
reimbursement. The CM PRN helps drive change by identifying areas
where performance improvement is needed (e.g., day-to-day workflow,
education, process improvements, patient satisfaction).
PEOPLE ESSENTIAL FUNCTIONS
- Collaborates with the physician and all members of the
interprofessional health care team to facilitate care for
designated case load; monitors the patient's progress, intervening
as needed to ensure that the plan of care and services provided are
patient-focused, high quality, efficient, and cost-effective;
facilitates timely:
- completion and reporting of diagnostic testing;
- completion of treatment plan and discharge plan;
- modification of plan of care, as necessary, to meet the ongoing
needs of the patient;
- assignment of appropriate levels of care;
- completion of all required documentation in EPIC and MIDAS
- Serves as a preceptor, as appropriate, and implements staff
education specific to patient populations and unit processes;
coaches and mentors other staff and students. Serves a resource for
case management and social work resources and needs for the
department and the hospital.
SERVICE ESSENTIAL FUNCTIONS
- Performs review for medical necessity of admission, continued
stay and resource use, appropriate level of care and program
compliance. Identifies when services no longer meet
InterQual/Millman l criteria, initiates discussion with attending
physicians, coordinates with the external case manager to
facilitate discharge planning, seeks assistance from the physician
advisor, if needed, and informs management of the possible need for
issuing Medicare Hospital Initiated Notice of Non-coverage.
- Applies approved utilization criteria to monitor
appropriateness of admissions, level of care, resource utilization,
and continued stay. Reviews level of care denials to identify
trends and collaborate with team to recommend opportunities for
process improvement.
QUALITY/SAFETY ESSENTIAL FUNCTIONS
- Documents assessment and interventions efficiently and
effectively.
- Plans for routine/difficult discharge and anticipates/prevents
and manages emergent situations. Specific focus given to discharge
plan and elimination of barriers.
- Performs post-discharge review by analyzing the inpatient
record to ensure that compliance with quality indicators are met.
Intervenes and takes appropriate action to foster real-time
compliance with CMS guidelines and other performance measures
associated with certification programs and other regulatory,
national, regional or locally- sponsored quality programs. Provides
reports, as needed, to appropriate parties showing:
- compliance with established governmental and/or institutional
rules and regulations
- analysis of problematic areas, and
- actions taken to improve compliance
- Conducts chart audits and performs peer-to-peer evaluations for
continuous quality improvement.
- Identifies opportunities to improve patient satisfaction with
focus on discharge domain and collaborates with unit leadership to
implement evidence-based patient engagement strategies.
FINANCE ESSENTIAL FUNCTIONS
- Monitors Length of Stay (LOS) for case load on an ongoing
basis. Identifies population and/or service-specific trends
impacting LOS and addresses/resolves problems impeding treatment
progress. Proactively takes action to achieve continuous
improvement and expedite care/facilitate discharge. Contributes to
meeting departmental financial target on scorecard
- Manages all patients in Observation Status, daily, informing
physicians of timely disposition options to assure maximum benefits
for patients and reimbursement for the hospital.
- Secures reimbursement for hospital services by communicating
medical information required by all external review entities,
managed care contracts, insurers, fiscal intermediaries, and state
and federal agencies. Responds to requests for information,
monitors covered days, and initiates review to assure that all days
are covered and reimbursable.
GROWTH/INNOVATION ESSENTIAL FUNCTIONS
- Provides education to unit-based physicians, nurses, and other
healthcare providers on any case management topics.
- Identifies opportunity for practice changes. Offers innovative
solutions through evidence-based practice/performance improvement
projects and shared governance activities.
- Identifies and presents areas for innovation, efficiency and
improvement in case management or department operations using
evidence-based practice literature. Completes and updates the
individual development plan (IDP) on an on-going basis.
This job description is not intended to be all-inclusive; the
employee will also perform other reasonably related business/job
duties as assigned. Houston Methodist reserves the right to revise
job duties and responsibilities as the need arises.
EDUCATION
- Graduate of education program approved by the credentialing
body for the required credential(s) indicated below in the
Certificates, Licenses and Registrations section.
WORK EXPERIENCE
- Three (3) years hospital clinical nursing experience which
includes two (2) years in case management
LICENSES AND CERTIFICATIONS - REQUIRED
- RN - Registered Nurse - Texas State Licensure and/or Compact
State Licensure within 90 days or
- RN-Temp - Registered Nurse - Temporary State Licensure within
90 days
KNOWLEDGE, SKILLS, AND ABILITIES
- Demonstrates the skills and competencies necessary to safely
perform the assigned job, determined through on-going skills,
competency assessments, and performance evaluations.
- Sufficient proficiency in speaking, reading, and writing the
English language necessary to perform the essential functions of
this job, especially with regard to activities impacting patient or
employee safety or security.
- Ability to effectively communicate with patients, physicians,
family members and co-workers in a manner consistent with a
customer service focus and application of positive language
principles.
- Strong assessment, organizational and problem-solving skill as
evidenced by capacity to prioritize multiple tasks and role
components
- Knowledge of Medicare, Medicaid and Managed Care requirements
- Comprehensive knowledge of community resources, health care
financial and payer requirements/issues, and eligibility for state,
local and federal programs
- Comprehensive 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.
- Ability to work independently
- Strong assessment, organizational and problem-solving skill as
evidenced by capacity to prioritize multiple tasks and role
components
- Demonstrates critical thinking and makes decisions using
evidence-based analytical approach in interactions with physicians,
payors, and patients and their families
- Well versed in computer skills of the entire Microsoft Office
Suite (Access, Excel, Outlook, PowerPoint and Word)SUPPLEMENTAL
REQUIREMENTS
WORK ATTIRE
- Uniform No
- Scrubs No
- Business professional Yes
- Other (department approved) NoON-CALL*
*Note that employees may be required to be on-call during
emergencies (ie. DIsaster, Severe Weather Events, etc) regardless
of selection below.
- On Call* YesTRAVEL**
**Travel specifications may vary by department**
- May require travel within the Houston Metropolitan area
Yes
- May require travel outside Houston Metropolitan area NoCompany
Profile:Houston Methodist The Woodlands Hospital opened in June
2017 as the eighth hospital in the Houston Methodist system. This
267-bed, 725,000-square-foot, full-service, acute-care hospital
offers many of the same services as our flagship hospital in the
Texas Medical Center. Also, on the beautiful hospital campus,
located at the intersection of Interstate 45 and Texas State
Highway 242, are two medical office buildings, which include a
Breast Care Center; Cancer Center; infusion center; heart and
vascular services; neurology; orthopedics and sports medicine;
rehabilitation services; wellness services; an outpatient
laboratory; and several other multispecialty physician practices.
In January 2022, Houston Methodist The Woodlands opened Healing
Tower - a $250 million expansion project that added 106 beds,
focused on medical-surgical and women's services, and provided nine
operating rooms. The project also included the expansion of the
endoscopy center, emergency department and diagnostic imaging
department with an enhanced neurodiagnostic and interventional
center.Houston Methodist is an equal opportunity employer inclusive
of women, minorities, disabled persons and veterans.Equal
Employment OpportunityHouston Methodist is an Equal Opportunity
Employer.Equal employment opportunity is a sound and just concept
to which Houston Methodist is firmly bound. Houston Methodist will
not engage in discrimination against or harassment of any person
employed or seeking employment with Houston Methodist on the basis
of race, color, religion, sex, sexual orientation, gender identity,
national origin, age, disability, status as a protected veteran or
other characteristics protected by law. VEVRAA Federal Contractor -
priority referral Protected Veterans requested.
Keywords: Houston Methodist The Woodlands Hospital, Conroe , Case Manager - PRN, Executive , New Waverly, Texas
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