Case Manager

Job Summary The purpose of the Case Manager position is to support the physician, primary medical homes, and interdisciplinary teams. The role integrates and coordinates resource utilization management, care facilitation, and discharge planning functions. The Case Manager helps drive change by identifying areas where performance improvement is needed, such as workflow, education, process improvements, and patient satisfaction. The position is accountable for a designated patient caseload, responding to patient needs across the continuum, providing family support, managing length of stay, and promoting efficient utilization of resources. Minimum Qualifications Education : Graduate of an accredited school of professional nursing required; Bachelors of Nursing preferred, or graduate of an accredited Master of Social Work program. Licenses/Certifications : Current and valid license to practice as a Registered Nurse in Texas or as a Master Social Worker (LMSW) in Texas required; LCSW preferred. Certification in Case Management required within two years of hire. Experience / Knowledge / Skills : Three years of nursing or social work experience in an acute hospital setting preferred, or three years of comparable clinical experience such as ambulatory surgery, infusion/dialysis, Federally Qualified Health Clinics, skilled nursing facilities, or wound clinics. Experience in utilization management, case management, discharge planning, or other cost/quality management programs preferred; excellent interpersonal communication, negotiation, leadership, analytical, data management, and PC skills required. Current knowledge of discharge planning, utilization management, performance improvement, disease or population management, and managed care reimbursement is essential. Understanding of pre‑acute and post‑acute venues of care, motivational interviewing, change management, and strong organizational and time‑management skills are required. Ability to work independently, exercise sound judgment, and communicate effectively in writing and orally are essential. Principal Accountabilities Coordinate and facilitate patient care progression throughout the continuum, collaborating with physicians, nursing, and multidisciplinary teams to ensure timely, appropriate patient care. Identify, resolve, and prevent delays or obstacles to discharge, seeking consultation from appropriate disciplines to expedite care. Maintain active communication with physicians, nurses, and other team members, documenting progress and interventions to meet patient‑focused, high‑quality, efficient, and cost‑effective goals. Complete and report diagnostic testing, treatment plans, and discharge plans; modify plans of care as needed; assign appropriate levels of care; and complete all required documentation in TQ screens and patient records. Collaborate with medical, nursing, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting, and complete Utilization Management and Quality Screening for assigned patients. Apply approved clinical appropriateness criteria, monitor admissions and continued stays, and document findings based on department standards. Identify at‑risk populations using approved screening tools, follow established reporting procedures, monitor length of stay and resource use, and take actions to achieve continuous improvement. Refer cases and issues to the Care Management Medical Director in compliance with department procedures and follow up as indicated. Communicate with the Resource Center to facilitate covered day reimbursement certification for assigned patients and resolve payor issues with clinical staff. Use quality screens to identify potential issues and forward information to the Clinical Quality Review Department. Ensure all critical elements of the plan of care are communicated and documented to patients, families, and the healthcare team. Manage all aspects of discharge planning, meeting patients and families to assess needs, develop individualized care plans, and collaborate with the multidisciplinary team throughout the process. Refer appropriate cases for social work intervention and collaborate with external case managers as needed. Initiate and facilitate referrals for home health, hospice, medical equipment, and supplies through the Resource Center. Participate in clinical performance improvement activities, assist in collecting and reporting financial indicators, and use data to drive decisions and plan/implement improvement strategies related to case management. Collect, analyze, and address variances from the plan of care with the physician or other team members, using concurrent variance data to drive practice changes and positively impact outcomes. Lead development, implementation, evaluation, and revision of clinical pathways and case management tools as a member of the clinical resource team. Assist in compiling physician profile data regarding LOS, resource utilization, denial days, costs, case mix index, patient satisfaction, quality indicators, and unplanned returns to the operating room. Act as preceptor or mentor to new hires, develop orientation schedules, and identify individual learning needs. Ensure safe care to patients, staff, and visitors; adhere to all Memorial Hermann policies, procedures, and standards within budgetary specifications. Promote professional growth by meeting mandatory and continuing education requirements and supporting department‑based goals. Demonstrate commitment to caring for every member of the community through compassionate, personalized experiences. Other duties as assigned. Equal Employment Opportunity Statement Memorial Hermann is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. #J-18808-Ljbffr