Certified Case Manager (RN) - Transition in Care (Medical Center - On-site)
Company: Houston Methodist Specialty Physician Group
Location: Bellaire
Posted on: October 3, 2024
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Job Description:
At Houston Methodist, the Case Manager (CM) Certified 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 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, 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 barriersQUALITY/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 in nursing Master's degree preferredWORK EXPERIENCE Five
years hospital clinical nursing experience which includes two years
in case managementLICENSES 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) -- National Board for Case ManagementKNOWLEDGE,
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 Specialty
Physician Group is an integral part of Houston Methodists overall
strategy to become one of the nations leading academic medical
centers. Established as a nonprofit corporation certified by the
Texas State Board of Medical Examiners, the Specialty Physician
Group enables physicians to maintain autonomy with respect to
clinical practice while growing their practice within an academic
environment.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.Required
Keywords: Houston Methodist Specialty Physician Group, Baytown , Certified Case Manager (RN) - Transition in Care (Medical Center - On-site), Professions , Bellaire, Texas
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