Overview

JOB SUMMARY

At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN) responsible for comprehensively planning for case management, which includes care transitions and discharge planning of a targeted patient population on a designated unit(s) and/or service lines. 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 position holds joint accountability with the social worker for discharge planning and continuity of care and assures that admission and continued stay are medically necessary, communicating clinical information to payors to ensure reimbursement.

Houston Methodist Standard

PATIENT AGE GROUP(S) AND POPULATION(S) SERVEDRefer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.
• Focuses on patient/customer safety
• Delivers personalized service using HM Service Standards
• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)
• Intentionally rounds with patients/customers to ensure their needs are being met
• Involves patients (customers) in shift/handoff reports byenabling their participation in their plan of care as applicable to the given job

• Displays cultural humility, diversity, equity and inclusion principles

• Actively supports the organization vision, fulfills the mission and abides by the I CARE values

Responsibilities

PRIMARY JOB RESPONSIBILITIES

Job responsibilities labeled EF capture those duties that are essential functions of the job.

PEOPLE - 20%

SERVICE - 25%

QUALITY/SAFETY - 20%

FINANCE - 25%

GROWTH/INNOVATION - 10%

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.

Qualifications

EDUCATION REQUIREMENTS

o Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section.

o Bachelor’s degree preferred

EXPERIENCE REQUIREMENTS

o Three years hospital nursing clinical experience

o Case management experience preferred

License/Certification

CERTIFICATIONS, LICENSES AND REGISTRATIONS REQUIRED

o Texas RN license or temporary TX RN license, should obtain permanent license within 90 days. Compact license acceptable according to current Board of Nursing requirements.

KSA/ Supplemental Data

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

o Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations

o 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

o 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

o Knowledge of Medicare, Medicaid and Managed Care requirements

o Progressive knowledge of community resources, health care financial and payor requirements/issues, and eligibility for state, local and federal programs

o Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement

o Understanding of pre-acute and post-acute venues of care and post-acute community resources

o Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families

o Well versed in computer skills of the entire Microsoft Office Suite (Excel, Outlook, PowerPoint and Word)

o Strong assessment, organizational and problem-solving skill

SUPPLEMENTAL REQUIREMENTS

Work Attire Yes/No

Uniform No

Scrubs No

Business professional Yes

Other (dept approved) No

On-Call* Yes, on a regular basis

*Note that employees may be required to be on-call during emergencies (i.e. Disaster, Severe Weather Event, etc.) regardless of selection above

Travel**

May require travel within Yes

Houston Metropolitan area

May require travel outside No

of Houston Metropolitan area

**Travel specifications may vary by department.

Please note any other special considerations to this job: __________________________

Company Profile

Since its founding in 1919, Houston Methodist Hospital has earned worldwide recognition. Houston Methodist Hospital is affiliated with the Weill Medical College of Cornell University and New York-Presbyterian Hospital, one of the nation's leading centers for medical education and research. In 2020, U.S. News & World Report named Houston Methodist Hospital to its top ranked Honor Roll for the fourth time and second consecutive year. 2020 also marked the ninth year in a row Houston Methodist Hospital has been named the No. 1 hospital in Texas. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 952 operating beds, 85 operating rooms and over 8,000 employees, Houston Methodist offers complete care for patients from around the world.

The same high-quality care for which Houston Methodist is known is available at several Emergency Care Centers in Houston and the surrounding areas. These Emergency Care Centers house exam rooms, full digital radiography suite, low radiation dose 16-slice CT scan, ultrasound and a full on-site stat chemistry lab.