About the role

Case Manager (RN) at Houston Methodist facilitating discharge planning and ensuring quality patient care. Collaborating with healthcare teams to support patient transitions and resource utilization.

Responsibilities

Communicates in an active, positive and effective manner to all health care team members
Collaborates with staff from the interprofessional health care team to improve outcomes
Uses a structured format for regular communication with patients and families
Assesses all patients timely and thoroughly
Participates in daily Care Coordination Rounds (CCR)
Supports patients and families in preventing/resolving clinical or ethical issues
Facilitates discharge planning activities for assigned patients
Maintains ownership of the discharge planning process on assigned units
Initiates and facilitates referrals for home health care, hospice, and durable medical equipment
Consults with Social Worker Case Manager to assess psychosocial needs associated with transition to alternative levels of care
Modifies care based on continuous evaluation of the patient's condition
Documents accurate assessment and interventions efficiently and effectively
Plans for routine discharge and elevates emergent situations
Performs review for medical necessity of admission, continued stay and resource use
Participates in denial mitigation activities to ensure appropriate reimbursement for services rendered
Contributes to meeting department and hospital financial target
Initiates evidence-based practice/performance improvement projects
Seeks opportunities to identify self-development needs and takes appropriate action

Graduate of education program approved by the credentialing body for the required credential(s)
Bachelor's degree preferred
Three years hospital nursing clinical experience
Case management experience preferred
RN - Registered Nurse - Texas State Licensure -- Compact Licensure - Must obtain permanent Texas license within 60 days (if establishing Texas residency)
Demonstrates the skills and competencies necessary to safely perform the assigned job
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job
Knowledge of Medicare, Medicaid and Managed Care requirements
Progressive knowledge of community resources, health care financial and payor requirements/issues, and eligibility for state, local and federal programs
Progressive 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 and exercise sound judgment in interactions
Well versed in computer skills of the entire Microsoft Office Suite