Work Shift: DAY
Work Week: Varies
At Houston Methodist, the Case Manager (CM) III position is a licensed registered nurse (RN) who works to promote the achievement of optimal clinical and resource outcomes, accountable for a designated patient caseload that is considered more complex and resource intensive. This position is responsible for facilitating appropriate lengths of stay (LOS) and reimbursement for all hospital admissions in accordance with its goals and objectives and assures that admission and continued stay are medically necessary, communicating clinical information to payers to ensure reimbursement. The CM III position analyzes current systems and variances to identify opportunities for improvement and acts as the key information and education resource for the interprofessional health care team. This position promotes and maintains compassionate, quality of care through collaboration with all service team members, patients and families and works with the leadership team for special project activities associated with each service line including LOS, readmissions, and utilization management to align and communicate the goals and visions. The CM III position will lead projects or perform specialized responsibilities as a regular part of their normal job responsibilities.
PRIMARY JOB RESPONSIBILITIES
Job responsibilities labeled EF capture those duties that are essential functions of the job.
PEOPLE - 25%
1. Promotes a positive work environment and leads the team to be a dynamic, team-focused work unit that actively helps one another to achieve optimal department results. Role models to team members effective communication skills, assisting in their development of such skills. Collaborates with all members of the patient care team by actively communicating and reporting pertinent patient care information and data in a comprehensive manner. (EF)
2. Works with physician leadership and the interprofessional healthcare team for defined patient populations to develop clinical pathways, continuum care management programs, measurement and feedback of performance indicators for cost, quality and service and patient satisfaction. Facilitates timely:
a. completion and reporting of diagnostic testing
b. completion of treatment plan and discharge plan
c. modification of plan of care, as necessary, to meet the ongoing needs of the patient
d. assignment of appropriate levels of care
e. completion of all required documentation in EPIC and MIDAS (EF)
3. Serves as the primary information resource for case management staff, payors, physicians, other healthcare team members and customers for the facility and the system. Acts as a formal preceptor/coach for new case management employees. Develops skills of team members and continually assists with improving skills, performance and outcomes. Provides feedback to management on team member performance and conduct. (EF)
4. Collaborates with leadership team on recruitment and retention strategies and key initiatives to improve employee relations, participation and engagement (EF)
SERVICE - 20%
1. Serves as a unit-based leader for comprehensive case management activities including assessing all patients and leading team to set discharge plan, participating in daily Care Coordination or Bedside Rounds, and identifying and leading resolution to barriers of efficient patient throughput. (EF)
2. Continuously reviews the total picture of the patient for opportunities for care facilitation and needs for discharge planning. Mentors others regarding specialty populations. (EF)
3. Independently handles resolution of complex problems and issues for department. Serves as escalation support for less experienced staff. Implements and leads initiatives to improve patient and family satisfaction related to discharge question(s) on HCAHPS. (EF)
QUALITY/SAFETY - 25 %
1. Identifies need for case management and/or social work intervention and implements strategies that improve care coordination metrics (LOS reduction, discharges before 11am and readmission reduction) by using clinical expertise and high risk screening tools. (EF)
2. Identifies opportunities for process improvement to improve the quality of case management and social work documentation, providing recommendations, and contributes to meeting departmental and hospital targets for quality and safety. Works with the Case Management and Social Work (CM/SW) leadership and IT team to create and/or enhance current operational and documentation of efficiencies to improve the quality of information entered in the medical record. (EF)
3. Performs chart audits to assess for compliance with disease-specific clinical pathway compliance. Tracks and trends performance and reports to CM/SW leadership. (EF)
FINANCE - 20%
1. Oversees the management of specific patient populations across the continuum, focusing on high-risk, high-cost patients. Takes leadership role in collaborating with employees to secure reimbursement for hospital services. Collaborates with CM/SW leadership on cost-reduction strategies for the department. Leads efforts to ensure appropriate capture of avoidable and excess days. Reports trends to CM/SW leadership team. (EF)
2. Functions as resource to department staff when communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, and state and federal agencies and collaborates with providers and CM/SW leadership team to mitigate denials. (EF)
3. Collaborates with CM/SW leadership on efforts to reduce length of stay (LOS) including serving as the resource to staff on proactively identifying and assessing difficult discharges, timely escalation to leadership and progressive care coordination for next level of care arrangement and transition. (EF)
GROWTH/INNOVATION - 10%
1. Actively participate in system-wide projects regarding Case Management related topics such as length of stay reduction, readmission prevention and utilization management. Reads and leads critique of evidence-based practice literature in case management and related disciplines. Fulfills role of leadership on at least one hospital or system-based committee. (EF)
2. Expands own knowledge and serves as instructor in continuing education or formal program and expert consultation; coaches staff to grow in knowledge, abilities, skills, and attitudes. Identifies, plans, and implements education for the unit and service line in collaboration with team members and interdisciplinary partners. (EF)
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.
o Bachelor¿s of Science degree in Nursing (BSN)
o master¿s degree preferred
o Seven (7) years hospital nursing clinical experience including five (5) years in case management
CERTIFICATES, 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.
o American Nursing Credentialing Center (ANCC)-recognized certification
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 Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families
o Strong assessment, organizational and problem solving skill as evidenced by capacity to prioritize multiple tasks and role components
o Knowledge of community resources, health care financial and payer issues, Medicare, Medicaid and Managed Care requirements and eligibility for state, local and federal programs
o Skill-specific areas include: regulatory requirements, pathway development/implementation, ethics/healthcare law, clinical skill, etc.
o Expert 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 Well versed in computer skills of the entire Microsoft Office Suite (Access, Excel, Outlook, PowerPoint and Word)
o Required passage of Interrater Reliability test (IRR)
o Maintains level of professional contributions as defined in Career Path program
Equal Employment Opportunity
Houston 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.
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. Houston Methodist is consistently ranked in U.S. News & World Report's “Best Hospital” list and was recently named the number one hospital in Texas. FORTUNE magazine has placed Houston Methodist on its annual list of “100 Best Companies To Work For” since 2006. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical, surgical and diagnostic techniques. With 1,119 licensed beds, 67 operating rooms and over 6,000 employees, Houston Methodist offers complete care for patients from around the world.
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