Case Manager (Weekend)
Company: Memorial Hermann Health System
Posted on: June 25, 2022
At Memorial Hermann, we're about creating exceptional
experiences for both our patients and our employees. Our goal is to
provide opportunities for our diverse employee population that
develop and grow careers in a team-oriented environment focused on
patient care.Every employee, at every level, begins their journey
at Memorial Hermann learning about the history of the organization
and its established culture built on trust and integrity. Our
employees drive this culture, and we want you to be a part of
it.Job SummaryThe purpose of the Case Manager position is to
support the physician, primary medical homes, and interdisciplinary
teams. Facilitates patient care, with the underlying objective of
enhancing the quality of clinical outcomes and patient satisfaction
while managing the cost of care and providing timely and accurate
information to payors. The role integrates and coordinates resource
utilization management, care facilitation and discharge planning
functions. In addition, the Case Manager helps drive change by
identifying areas where performance improvement is needed (e.g.,
day to day workflow, education, process improvements, patient
satisfaction). The position is responsible for coordinating a wide
range of self management support and provides information to update
and maintain relevant disease registry activity. Accountable for a
designated patient caseload and plans effectively in order to meet
patient needs across the continuum, provide family support, manage
the length of stay, and promote efficient utilization of
resources.Job DescriptionMinimum QualificationsEducation: Graduate
of an accredited school of professional nursing required; Bachelors
of Nursing preferred, or graduate of an accredited masters of
social work programLicenses/Certifications:
- Current and valid license to practice as a Registered Nurse in
the state of Texas or
- Current and valid license as a Master Social Worker (LMSW) in
the state of Texas required, LCSW preferred
- Certification in Case Management required within two (2) years
of hire into the Case Manager positionExperience / Knowledge /
- Three (3) years of experience in hospital-based nursing or
- Experience in utilization management, case management,
discharge planning or other cost/quality management program
- Excellent interpersonal communication and negotiation
- Demonstrated leadership skills
- Strong analytical, data management and PC skills
- Current working knowledge of discharge planning, utilization
management, case management, performance improvement, disease or
population management and managed care reimbursement
- Understanding of pre-acute and post-acute venues of care and
post-acute community resources, physician office routines, and
transitional procedures for pre and post acute care. Demonstrated
understanding of motivational interviewing and change
- Strong organizational and time management skills, as evidenced
by capacity to prioritize multiple tasks and role components
- Ability to work independently and exercise sound judgment in
interactions with physicians, payors, and patients and their
- Effective oral and written communication skills
- Demonstrates commitment to the Partners-in-Caring process by
integrating our culture in all internal and external customer
interactions; delivers on our brand promise of "we advance health"
through innovation, accountability, empowerment, collaboration,
compassion and results while ensuring one Memorial
- Coordinates/facilitates patient care progression throughout the
- Works collaboratively and maintains active communication with
physicians, nursing and other members of the multi-disciplinary
care team to effect timely, appropriate patient care.
- Addresses/resolves system problems impeding diagnostic or
- Proactively identifies and resolves delays and obstacles to
- Seeks consultation from appropriate disciplines/departments as
required to expedite care and facilitate discharge.
- Utilizes advanced conflict resolution skills as necessary to
ensure timely resolution of issues.
- Collaborates with the physician and all members of the
multidisciplinary team to facilitate care for designated case load.
Monitors the patient's progress, intervening as necessary and
appropriate to ensure that the plan of care and services provided
are patient focused, high quality, efficient, and cost
- Facilitates the following on a timely basis: Completes and
reports diagnostic testing, Completes treatment plan and discharge
plan, Modifies plan of care as necessary, to meet the ongoing needs
of the patient, Communicates to third party payors and other
relevant information to the care team.
- Assigns appropriate levels of care.
- Completes all required documentation in TQ screens and patient
- Collaborates with medical staff, nursing staff, and ancillary
staff to eliminate barriers to efficient delivery of care in the
- Completes Utilization Management and Quality Screening for
- Applies approved clinical appropriateness criteria to monitor
appropriateness of admissions and continued stays, and documents
findings based on Department standards.
- Identifies at-risk populations using approved screening tool
and follows established reporting procedures. Monitors LOS and
ancillary resource use on an ongoing basis.
- Takes actions to achieve continuous improvement in both
- Refers cases and issues to Care Management Medical Director in
compliance with Department procedures and follows up as
- Communicates with Resource Center to facilitate covered day
reimbursement certification for assigned patients.
- Discusses payor criteria and issues on a case-by-case basis
with clinical staff and follows up to resolve problems with payors
- Uses quality screens to identify potential issues and forwards
information to Clinical Quality Review Department.
- Ensures that all elements critical to the plan of care have
been communicated to the patient/family and members of the
healthcare team and are documented as necessary to assure
continuity of care.
- Manages all aspects of discharge planning for assigned
- Meets directly with patient/family to assess needs and develop
an individualized continuing care plan in collaboration with
- Collaborates and communicates with multidisciplinary team in
all phases of discharge planning process, including initial patient
assessment, planning, implementation, interdisciplinary
collaboration, teaching and ongoing evaluation.
- Ensures/maintains plan consensus from patient/family, physician
- Refers appropriate cases for social work intervention based on
- Collaborates/communicates with external case managers.
- Initiates and facilitates referrals through the Resource Center
for home health care, hospice, medical equipment and supplies.
- Documents relevant discharge planning information in the
medical record according to Department standards.
- Facilitates transfer to other facilities as appropriate.
- Actively participates in clinical performance improvement
- Assists in the collection and reporting of financial indicators
including case mix, LOS, cost per case, excess days, resource
utilization, readmission rates, denials and appeals.
- Uses data to drive decisions and plan/implement performance
improvement strategies related to case management for assigned
patients, including fiscal, clinical and patient satisfaction
- Collects, analyzes and addresses variances from the plan of
care/care path with physician and/or other members of the
- Uses concurrent variance data to drive practice changes and
positively impact outcomes.
- Collects delay and other data for specific performance and/or
outcome indicators as determined by Director of Outcomes
Management. Documents key clinical path variances and outcomes
which relate to areas of direct responsibility (e.g., discharge
- Uses pathway data in collaboration with other disciplines to
ensure effective patient management concurrently.
- Leads the development, implementation, evaluation and revision
of clinical pathways and other Case management tools as a member of
the clinical resource/team.
- Assists in compilation of physician profile data regarding LOS,
resource utilization, denied days, costs, case mix index, patient
satisfaction and quality indicators (e.g., readmission rates,
unplanned return to OR, etc.)
- Acts as preceptor/mentor to new hires.
- Assists in development of orientation schedule and helps
identify individual needs for learning.
- Ensures safe care to patients, staff and visitors; adheres to
all Memorial Hermann policies, procedures, and standards within
budgetary specifications including time management, supply
management, productivity and quality of service.
- Promotes individual professional growth and development by
meeting requirements for mandatory/continuing education and skills
competency; supports department-based goals which contribute to the
success of the organization; serves as preceptor, mentor and
resource to less experienced staff.
- Other duties as assigned.
Keywords: Memorial Hermann Health System, Pearland , Case Manager (Weekend), Executive , Pearland, Texas
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