Case Manager

Lead Case Manager

Facilitates patient care by assessing patient needs, evaluating treatment options, creating treatment plans, coordinating care, and gauging progress. The lead case manager is responsible for overseeing the case management team and serves as the primary point of contact between the case managers and executive leadership. OSHA Bloodborne Pathogens Class I.

Essential Responsibilities:

• Coordinates and facilitates patient care through assessment, evaluation, planning, and implementation.
• Serves as the primary case management contact for other departments within the district.
• Oversee and assist all members of the case management team.
• Works closely with executive leadership to address departmental issues and concerns.
• Consults with healthcare team to identify patients' needs and treatment options.
• Determines patients' eligibility for services through multidisciplinary team members.
• Works with physician to refer services available within the hospital district.
• Works with patient and family regarding plan of care after services, if needed.
• Monitors and compiles information regarding the necessity of services within the district.
• Reviews patient records to assemble utilization review information.
• Maintains records and supports the district in utilization matters.
• Completes accurate, timely records for submission to business office to coordinate billing flow between the district and outside agencies.
• Prepares and presents education sessions and materials for medical staff members and the outpatient clinic staff.

Patient Advocate Duties:

• Identify the need for additional services for patients.
• Build a network of federal, state and community resources.
• Maintains records for all assistance programs used and people helped through these services.
• Maintains confidentiality while working with confidential matters on a daily basis.
• Interacts with patients, family members, medical staff members and other department managers on a continuous basis.
• Conducts patient satisfaction surveys as required
• Follows safety guidelines and infection control policies for the Hospital District.
• Any other duties as assigned.

Job Qualifications:

• Education: High school graduate or equivalent. Associate's degree in nursing. Bachelor's degree preferred.
• Job Related Skills: Possess reading and verbal skills necessary to understand medical records and procedures and to communicate effectively with patients and other staff. Knowledge of Medicare, Medicaid and welfare programs preferred.
• Licensure, Registry or Certification: Registered Nursing License with the availability to work in the state of Texas.
• Experience: One year experience as a clinical case manager preferred. Prior experience in quality assurance or utilization review activities preferred.
• Physical and Mental Requirements: This position requires moderate periods of standing and walking.