Manager, Case Management (on the Adult side)

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

This position is on the adult side. Not Pediatric.

The Manager of Case Management is responsible and accountable to assist the Director of Case Management in the implementation of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, Utilization Management, Case Management and Discharge Planning.

The Manager is responsible for coordinating the use systems and processes for care/utilization management at the hospital level. In addition, the Manager is responsible for to assist the Director in managing the department’s activities related to discharge planning and clinical quality improvement. The Manager coordinates day to day departmental operations and the use of hospital resources appropriately and effectively. The Manager participates in the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement.

Job Description

Minimum Qualifications

Education : Bachelor's of Science in Nursing OR Social Work (BSW). Master’s degree preferred*

*Note: effective March 1, 2019 and going forward, these are the minimum qualifications for this role; incumbents hired before March 1, 2019 may have commensurate experience in lieu of BSN.

Licenses/Certifications :

• Current and valid license to practice as a Registered Nurse in the state of Texas  or

• Licensed Master Social Worker (LMSW) required, LCSW preferred

• Case Manager Certification required

Experience/ Knowledge/ Skills:

• Minimum five (5) years' experience in utilization management, case management, discharge planning or other cost/quality management program

• Three (3) years of experience in hospital-based nursing or social work

• Three (3) years of demonstrated leadership experience

• Knowledge of leading practice in clinical care and payor requirements

• Self-motivated, proven communication skills, assertive

• Background in business planning, and targeted outcomes

• Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management

• Working knowledge of the concepts associated with Performance Improvement

• Demonstrated effective working relationship with physicians

• Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes

• Effective oral and written communication skills

Principal Accountabilities

• Assists in supervising and managing all aspects of the local level program.

• Supports growth and development of the case management program consistent with enterprise-wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed.

• Responsible for coordinating day to day operations of the program at the unit level.

• Assists in identifying and achieving optimal targeted financial outcomes via the inpatient case management process.

• Participates in departmental personnel functions (hiring, firing, etc.) in conjunction with the Director of Case Management.

• Provides input to annual and interim performance appraisal reviews for the professional and non-professional staff in department.

• Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospitalists, community care managers, nurses, community resources, etc.)

• Responsible for leading a high-performance team of “system thinkers” who incorporate leadership principles and vision in performing the functions of case management.

• Uses data to drive decisions, plan, and implement performance improvement strategies for case management.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.