System Float Pool - Case Manager-PRN (36 hrs/week)
Company: Houston Methodist
Location: Houston
Posted on: October 18, 2024
Job Description:
Case Manager-PRN
- 18 shifts in a 6 week period (4 weekend shifts)
- Must work 1 major holiday, 2 minor holidays
- No benefits No PTO
- Must float to all Houston Methodist hospitals
- Mileage reimbursed
- Magnet - ANCC Recognized Certification -- Case
Management-related OR ACM - Accredited Case Manager (NBCM)
REQUIREDAt Houston Methodist, the System Float Pool Case Manager
(CM) Certified 1 position is a registered nurse (RN) responsible
for comprehensively planning for case management of a targeted
patient population on a designated unit(s) and/or service line.
This position works with the physicians and interprofessional
healthcare team to facilitate and maintain compassionate, efficient
quality care and achievement of desired treatment outcomes. The CM
Certified 1 position holds joint accountability with social workers
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. In addition
to performing the duties of a CM, this position helps drive change
by identifying areas where performance improvement is needed, e.g.,
day-to-day workflow, education, process improvements, and patient
satisfaction.
PEOPLE ESSENTIAL FUNCTIONS
- Collaborates with the physician and all members of the
interprofessional healthcare team to facilitate care for designated
assignment; 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.
- Serves as a preceptor and implements staff education specific
to patient populations and unit processes; coaches and mentors
other staff and students. Serves a resource for department and
hospital. Provides education to physicians, nurses, and other
healthcare providers on case management topics.
- Conducts self in a manner that is congruent with cultural
diversity, equity and inclusion principles. Initiates contributions
towards improvement of department scores for employee engagement,
i.e., peer-to-peer accountability.
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/Milliman 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.
- Plans for routine/difficult discharge and anticipates/prevents
and manages emergent situations.
- Facilitates timely:
- Assessment and intervention to prevent or reduce readmission
- 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 designated EMR and
applications or programs
- elimination of discharge barriers
QUALITY/SAFETY ESSENTIAL FUNCTIONS
- Documents assessment and interventions efficiently and
effectively. Proactively takes action to achieve continuous
improvement and expedite care/facilitate discharge.
- 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 assigned cases on an ongoing
basis. Identifies population and/or service-specific trends
impacting LOS and addresses/resolves problems impeding treatment
progress. Contributes to meeting department and hospital financial
targets, with focus on length of stay.
- Manages all patients in Observation Status, 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, state, and
federal agencies. Responds to requests for information, monitors
covered days, initiates review to assure that all days are covered
and reimbursable.
GROWTH/INNOVATION ESSENTIAL FUNCTIONS
- Identifies opportunity for practice changes. Offers innovative
solutions through evidence-based practice/performance improvement
projects and shared governance activities.
- Seeks opportunities to identify self-development needs and
takes appropriate action. Ensures own career discussions occur with
appropriate management. Completes and updates the My Development
Plan 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
- Bachelor's degree or higher from an accredited school of
nursing
- Master's degree preferred
WORK EXPERIENCE
- Five years hospital clinical nursing experience which includes
two years in case management
LICENSES AND CERTIFICATIONS - REQUIRED
- RN - Registered Nurse - Texas State Licensure and/or Compact
State Licensure within 60 days OR
- RN-Temp - Registered Nurse - Temporary State Licensure within
60 days AND
- Magnet - ANCC Recognized Certification -- Case
Management-related OR
- ACM - Accredited Case Manager (NBCM)
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
- Comprehensive knowledge of Medicare, Medicaid and Managed Care
requirements
- Comprehensive knowledge of community resources, health care
financial and payor 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
- Competent computer skills of the entire Microsoft Office Suite
(Access, Excel, Outlook, PowerPoint and Word)SUPPLEMENTAL
REQUIREMENTSWORK 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 is one of the nation's leading health
systems and academic medical centers. Houston Methodist consists of
eight hospitals: Houston Methodist Hospital, its flagship academic
hospital in the heart of the Texas Medical Center, and seven
community hospitals throughout the greater Houston area. Houston
Methodist also includes an academic institute, a comprehensive
residency program, a global business division, numerous physician
practices and several free-standing emergency rooms and outpatient
facilities. Overall, Houston Methodist employs more than 27,000
employees and is supported by a wide variety of business functions
that operate at the system level to help enable clinical
departments to provide high quality patient care.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, Baytown , System Float Pool - Case Manager-PRN (36 hrs/week), Accounting, Auditing , Houston, Texas
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