Case Manager Advanced - Emergency Room

This position will focus on comprehensive emergency room initial assessments and multi-visit patients.

At Houston Methodist, the Case Manager (CM) Advanced position is responsible for promoting the achievement of optimal clinical and resource outcomes, accountable for assignment that is considered more complex and resource intensive. In addition to performing the duties and responsibilities of the CM Certified, this position has achieved an expert level at all the objectives delineated in the Case Manager and Case Manager Certified job roles and is responsible for facilitating appropriate length of stay (LOS) and reimbursement for all hospital admissions in accordance with set goals and objective. The Advanced CM position analyzes 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 related but not limited to, throughput, readmissions, and utilization management to align with the visions and goals of the department and organization. The CM Advanced position will, in the absence of management, serve as the primary resource for the department. This position will also lead projects or perform specialized responsibilities including oversight of staff, in the absence of leadership, as a regular part of their normal job responsibilities.

FLSA STATUS
Exempt

QUALIFICATIONS

EDUCATION

• Bachelor’s degree or higher from an accredited school of nursing
• Master’s degree preferred

EXPERIENCE

• Seven years hospital clinical nursing experience which includes five years in case management

LICENSES AND CERTIFICATIONS
Required

• RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency) and
• Magnet ANCC-recognized Case Management certification: ACHPN-HPCC or CCM or CMC or ACM-NBCM or CDCES or CHPN-HPCC or CMGT-BC or CM-ABOHN or CMCN or ANCC-NCM or CMC-NACCM or COHN or COHN/CM or CPHRM

KNOWLEDGE AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations
• 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
• 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
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families
• Strong assessment, organizational and problem-solving skill as evidenced by capacity to prioritize multiple tasks and role components
• Knowledge of community resources, health care financial and payer issues, Medicare, Medicaid and Managed Care requirements and eligibility for state, local and federal programs
• Skill-specific areas include: regulatory requirements, pathway development/ implementation, ethics/healthcare law, clinical skill, etc.
• Expert 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
• Proficient in computer skills of the entire Microsoft Office Suite (Access, Excel, Outlook, PowerPoint and Word)

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

• 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. Acts as a role model to team members, exemplifying effective communication skills.
• Works with physician leadership and the multidisciplinary 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.
• Serves as the primary information resource for case management staff, payors, physicians, other healthcare team members and customers. 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. Performs specialized responsibilities including oversight of staff, in the absence of leadership, as a regular part of job responsibilities.
• Collaborates with leadership team on recruitment and retention strategies and key initiatives to improve employee relations, participation and engagement. Implements strategies towards improvement of employee engagement as reflected by department scores, i.e., peer-to-peer accountability.

SERVICE ESSENTIAL FUNCTIONS

• Serves as a leader for comprehensive case management activities including assessing all patients and leading team to set discharge plan, participating in daily rounds or discussions, identifying and leading resolution of barriers to efficient patient throughput.
• Works with the department leadership to create and/or enhance current operational and documentation of efficiencies to improve the quality of information in the medical record. Continuously reviews the total picture of the patient for opportunities for care facilitation and needs for discharge planning. Mentors others regarding specialty populations
• Independently handles resolution of complex problems and issues. Serves as escalation support for all staff and proactively escalates appropriate discharge barriers to leadership and/or physician advisor. Implements and leads initiatives to improve patient and family satisfaction related to discharge question(s) on HCAHPS.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Proactively 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.
• Actively participates in system-wide projects regarding Case Management related topics such as length of stay reduction, readmission prevention, utilization management denial mitigation and appeal resolution. Proactively identifies opportunities for process improvement to improve the quality of case management and social work documentation, providing recommendations to meeting department and hospital targets for quality and safety in accordance with regulatory, national, regional or locally- sponsored quality programs.
• Independently performs IMM and chart audits to assess compliance with department-specific tasks and documentation. Tracks and trends performance and reports to department leadership.

FINANCE ESSENTIAL FUNCTIONS

• Oversees the management of specific patient populations across the continuum, focusing on high-risk, high-cost patients. Collaborates with department leadership on cost-reduction strategies. Leads efforts to ensure appropriate capture of avoidable and excess days. Reports trends to department leadership team and develops action strategies to overcome barriers.
• Functions as resource to department staff in communicating medical information required by external review entities, managed care contractors, insurers, fiscal intermediaries, state, and federal agencies. Collaborates with the appropriate resources to mitigate denials for barriers to discharge and get patients to the appropriate level of care timely.
• Collaborates with department 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, and progressive care coordination for next level of care arrangement and transition.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• 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. Reads and leads critique of evidence-based practice literature in case management and related disciplines. Identifies, plans, and implements education for the unit and service line in collaboration with team members and interprofessional partners.
• Represents the department at entity committees and activities; serves as chair/co-chair on department council. Fulfills role of leadership on at least one hospital or system-based committee. Actively leads shared governance activities. Seeks opportunities to identify self-development needs and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates the My Development Plan on an ongoing basis.

SUPPLEMENTAL REQUIREMENTS
WORK ATTIRE

• Uniform: No
• Scrubs: No
• Business professional: Yes
• Other (department approved): No

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.

• On Call* Yes

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area No

QUALIFICATIONS

EDUCATION

• Bachelor’s degree or higher from an accredited school of nursing
• Master’s degree preferred

EXPERIENCE

• Seven years hospital clinical nursing experience which includes five years in case management

LICENSES AND CERTIFICATIONS
Required

• RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency) and
• Magnet ANCC-recognized Case Management certification: ACHPN-HPCC or CCM or CMC or ACM-NBCM or CDCES or CHPN-HPCC or CMGT-BC or CM-ABOHN or CMCN or ANCC-NCM or CMC-NACCM or COHN or COHN/CM or CPHRM