Case Manager II (RN)
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POST DATE 5/18/2017
END DATE 7/20/2017
JOB DESCRIPTIONJob Summary
JOB SUMMARY: Comprehensively plans for Case Management of a targeted patient population. Holds joint accountability with social worker for facilitating psychosocial and continuing care. Work with the physicians and multidisciplinary care team to facilitate efficient, quality care and achievement of desired treatment outcomes. Communicate clinical information to payers to ensure reimbursement. Collaborates with Performance Improvement to collect and analyze patient care and fiscal data related to target case types.
DUTIES AND RESPONSIBILITIES:
1. Assesses the total picture of every patient through patient/family, physical assessment as indicated, and review of the Medical Record including H&P, lab and other test results/findings, plans of care, physician orders, nursing and progress notes to identify needs and develop a plan.
2. Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization and continued stay; documents findings based on standards on UR Worksheet.
3. Works collaboratively and maintains active communication with physicians, nursing and other members of the multidisciplinary care team to effect timely patient management, addresses and resolves process problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge.
4. Identifies barriers affecting timely patient management and documents avoidable days.
5. Facilitate communication with payers and external Case managers by documenting days certified proactively and concurrently resolving any denied days or delays.
6. Assist physicians, care providers, and patient/family in understanding payer plans / benefits and working within patient`s payer plans in order to maximize patients benefits and minimize out of pocket expense for patients.
7. Discharge planning for assigned patients in collaboration with the social worker.
8. Demonstrates the components of the I CARE values statement (Integrity, Compassion, Accountability, Respect, Excellence).
9. Demonstrates ServicePRIDE standards ( Smile and make eye contact; greet each patient and visitor; seek out patient and visitor contact; displays appropriate body language at all times; take 5 minutes each day to go above and beyond for 1 patient or visitor; honor diversity; thanks every customer).
10. Follows all safety rules while on the job. Reports accidents promptly and corrects minor safety hazards.
11. Perform other duties as assigned.
Bachelor s degree in Nursing; may consider ADN with additional relevant experience
If BSN prepared, 2 years RN experience in an acute care Hospital setting required; and
18 months of Case Management experience required
If ADN prepared, 2 years RN experience in an acute care Hospital setting required; and
3 years of Case Management experience required
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
Registered Nurse with current Texas license
American Heart Association BLS preferred
Magnet recognized Case Management Certification preferred
SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
* Must maintain level of professional contributions & competencies as defined in Clinical Career Path program guide.
* Knowledge of Medicare, Medicaid and Managed Care requirements (acquired within 6 months of hire)
* Works independently with minimal supervision
* Strong assessment, organizational and problem solving skill
* Knowledge of community resources (acquired within 6 months of hire)
* Knowledge of health care financial and payer issues, and eligibility for state, local and federal programs (acquired within 6 months of hire)
* Computer skills
* Advanced oral and written communication skills
* Collaboration, negotiation, and mediation skills
* Time management and prioritization skills
* Critical thinking
Equal Employment Opportunity
Equal employment opportunity is a sound and just concept to which Methodist is firmly bound. Methodist will not engage in discrimination against or harassment of any person employed or seeking employment with Methodist on the basis of race, color, national origin, religion, sex, physical or mental disability, medical condition, ancestry, marital status, age, sexual orientation, citizenship, genetic information or status as a Vietnam-era veteran or special disabled veteran.
Houston Methodist Willowbrook Hospital opened its doors to Northwest Houston in December 2000. In May 2010, a major expansion on the 52-acre campus doubled the size of the hospital, brining more expertise, more state-of-the-art technology and more specialized care to the community. With 251 licensed beds, 14 operating rooms and over 1,400 employees, Houston Methodist Willowbrook Hospital was specifically designed to provide comprehensive, personalized care for the community. APPLY.