RN, Case Manager, Inpatient (NEX)

RN Case Manager (Nex)

The RN Case Manager (Nex) uses a collaborative process to plan, assess, implement, monitor and evaluate the options and services required to meet the healthcare needs of the patients using the functions of Utilization Review using Interqual and Milliman Care Guidelines, Discharge Planning and Case Management in order to facilitate: (1) quality of patient care; (2) cost effective utilization and outcome management; (3) communication between patients, families, and members of the health care team; (4) expedition of the movement of patients through appropriate levels of care; and (5) information gathering for Quality & Risk Management utilizing Joint Commission Accreditation of Healthcare standards and clinical indicators. The Case Manager will assist with the identification of appropriate providers and facilities throughout the continuum of care, to ensure that resources of both CCMC and the patient are used in a timely and cost-effective manner to meet the healthcare needs of the patient.

Education and Experience

• Associate degree in nursing required. BSN from an accredited college or university is preferred.

• At least three years of any combination of experiences working in/with case management, care coordination, utilization review, patient intake, discharge planning and troubleshooting fund resources, quality assurance, clinical pathways, continuous quality improvement, or state and federal health plans or commercial insurance plans in a clinical or managed care environment.

• Must be computer literate, and have effective organizational, interpersonal, written, and oral communication skills.

• Must be familiar with various community resources and charitable organizations.

• Must be able to adapt to changing healthcare environments and work with all members of the healthcare team to achieve positive outcomes.

• Must have experience using or navigating electronic medical records (e.g., EPIC, Meditech, Healthy Planet, etc.).

• Bilingualism is preferred or may be required depending on the specific department assignment.

Licensure, Registration, and/or Certification

• Current RN license from Texas Board of Nursing required

• Must achieve a Basic Life Support (BLS) certification for Health Care Providers within 30 days of employment and must maintain this certification as per Medical Center Policy, MC 175*.

• Case Manager Certification (CCM) preferred.

*This requirement does not apply to Health Plan