staff - Registered Nurse (RN) - Case Management - $45+ per hour

Memorial Hermann Health System is seeking a Registered Nurse (RN) Case Manager in Katy, Texas. Job Summary The 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. Responsibilities Coordinate/facilitate patient care progression throughout the continuum. Work collaboratively and maintain active communication with physicians, nursing and other members of the multi‑disciplinary care team to effect timely, appropriate patient care. Address and resolve system problems impeding diagnostic or treatment progress. Proactively identify and resolve delays and obstacles to discharge. Seek consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge. Utilize advanced conflict resolution skills as necessary to ensure timely resolution of issues. Collaborate with the physician and all members of the multidisciplinary team to facilitate care for designated case load. Monitor 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 effective. Facilitate the following on a timely basis: complete and report diagnostic testing, complete treatment and discharge plans, modify plan of care as necessary to meet the ongoing needs of the patient, and communicate to third‑party payors and other relevant information to the care team. Assign appropriate levels of care and complete all required documentation in TQ screens and patient records. Collaborate with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting. Complete Utilization Management and Quality Screening for assigned patients. Apply approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and document findings based on department standards. Identify at‑risk populations using approved screening tool and follow established reporting procedures. Monitor LOS and ancillary resource use on an ongoing basis and take actions to achieve continuous improvement. Refer cases and issues to Care Management Medical Director in compliance with department procedures and follow up as indicated. Communicate with Resource Center to facilitate covered day reimbursement certification for assigned patients. Discuss payor criteria and issues on a case‑by‑case basis with clinical staff and follow up to resolve problems with payors as needed. Use quality screens to identify potential issues and forward information to Clinical Quality Review Department. Ensure 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. Manage all aspects of discharge planning for assigned patients. Meet directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician. Collaborate and communicate with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation. Ensure/maintain plan consensus from patient/family, physician and payor. Refer appropriate cases for social work intervention based on department criteria. Collaborate/communicate with external case managers and initiate and facilitate referrals through the Resource Center for home health care, hospice, medical equipment and supplies. Document relevant discharge planning information in the medical record according to department standards. Facilitate transfer to other facilities as appropriate. Actively participate in clinical performance improvement activities. Assist in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals. Use data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data. Collect, analyze and address variances from the plan of care/care path with physician and/or other members of the healthcare team. Use concurrent variance data to drive practice changes and positively impact outcomes. Collect delay and other data for specific performance and/or outcome indicators as determined by Director of Outcomes Management. Document key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning). Use pathway data in collaboration with other disciplines to ensure effective patient management concurrently. Lead the development, implementation, evaluation and revision of clinical pathways and other case management tools as a member of the clinical resource/team. Assist 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.). Act as preceptor/mentor to new hires. Assist in development of orientation schedule and help identify individual needs for learning. Ensure safe care to patients, staff and visitors; adhere to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service. Promote individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; support department‑based goals which contribute to the success of the organization; serve as preceptor, mentor and resource to less experienced staff. Demonstrate commitment to caring for every member of our community by creating compassionate and personalized experiences. Model Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues. Other duties as assigned. Minimum Qualifications Graduate of an accredited school of professional nursing (required); Bachelor of Nursing preferred, or graduate of an accredited Master of Social Work program. 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 position. Experience / Knowledge / Skills Three (3) years of nursing or social work experience in an acute hospital‑based setting preferred, or three (3) years of experience in a comparable clinical setting (e.g., ambulatory surgery center, infusion/dialysis clinic, Federally Qualified Health Clinic, skilled nursing facility, or wound clinic). Experience in utilization management, case management, discharge planning or another cost/quality management program preferred. Excellent interpersonal communication and negotiation skills; 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 management. 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 families. Effective oral and written communication skills. Benefits Dental benefits. Vision benefits. Employee assistance programs. 403(b) retirement plan. Health Care FSA. Dependent Care FSA. School loan reimbursement. #J-18808-Ljbffr Memorial Hermann Health System