Case Manager Advanced (RN) - Emergency Room

Come lead with us at Houston Methodist Baytown Hospital. This position will focus on comprehensive emergency room initial assessments and multi-visit patients.

SUMMARY

The Case Manager (CM) Advanced position is responsible for promoting the achievement of optimal clinical and resource outcomes. In addition to performing the duties of the CM Certified, this role has achieved an expert level in all 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 objectives. The Advanced CM analyzes variances to identify opportunities for improvement and acts as the key information and education resource for the interprofessional health‑care team.

ESSENTIAL FUNCTIONS

People Essential Functions Promotes a positive work environment and leads the team to be dynamic and team‑focused, actively helping one another to achieve optimal department results. Works with physician leadership and the multidisciplinary health‑care team for defined patient populations to develop clinical pathways, continuum‑care management programs, measurement and feedback of performance indicators for cost, quality, service and patient satisfaction. Serves as the primary information resource for case management staff, payors, physicians, other health‑care team members and customers. Acts as a formal preceptor/coach for new case management employees and develops skills of team members, continually assisting with improvement of performance and outcomes. Collaborates with leadership on recruitment, retention strategies and key initiatives to improve employee relations, participation and engagement, implementing strategies toward improved employee engagement reflected by department scores. Service Essential Functions Leads comprehensive case management activities including assessing all patients and leading the team to set discharge plans, participating in daily rounds or discussions, and identifying and resolving barriers to efficient patient throughput. Works with department leadership to create and/or enhance operational documentation of efficiencies, improving the quality of information in the medical record. Mentors others regarding specialty populations. Independently resolves complex problems and issues, serving as escalation support for all staff, proactively escalating appropriate discharge barriers to leadership and/or physician advisor. Implements and leads initiatives to improve patient and family satisfaction related to discharge questions on HCAHPS. Quality/Safety Essential Functions Proactively identifies the need for case management and/or social work intervention and implements strategies that improve care‑coordination metrics (LOS reduction, discharges before 11 a.m. and readmission reduction) using clinical expertise and high‑risk screening tools. Participates in system‑wide projects regarding case‑management topics such as LOS reduction, readmission prevention, utilization‑management denial mitigation and appeal resolution. Performs IMM and chart audits to assess compliance with department‑specific tasks and documentation, tracking performance and reporting to leadership. Finance Essential Functions Oversees management of specific patient populations across the continuum, focusing on high‑risk, high‑cost patients. Collaborates with leadership on cost‑reduction strategies and leads efforts to ensure appropriate capture of avoidable and excess days. Serves as a resource to staff in communicating medical information required by external review entities, managed‑care contractors, insurers, and state and federal agencies. Collaboration with leadership on efforts to reduce LOS, including proactive identification of difficult discharges, timely escalation, and progressive care coordination for next‑level 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. Leads critique of evidence‑based practice literature, identifies, plans, and implements education for the unit and service line in collaboration with interprofessional partners. Represents the department at entity committees and activities; chairs/co‑chairs on department council and fulfills a leadership role on at least one hospital or system‑based committee. Actively leads shared governance activities, seeks opportunities for self‑development and takes appropriate action, ensuring career discussions occur with appropriate management.

SUPPLEMENTAL REQUIREMENTS

Work Attire Uniform: No Scrubs: No Business professional: Yes Other (department approved): No On‑Call Employees may be required to be on‑call during emergencies (e.g., Disaster, Severe Weather Events, etc.) regardless of selection below. On Call: Yes Travel Travel specifications may vary by department. Travel within the Houston Metropolitan area: Yes Travel outside Houston Metropolitan area: No

QUALIFICATIONS

Education Bachelor’s degree or higher from an accredited school of nursing Master’s degree preferred Required Licenses & Certifications Registered Nurse (RN) – Texas State Licensure – Texas Board of Nursing; PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency) Magnet ANCC‑recognized Case Management certification: ACHPN‑HPCC, CCM, CMC, ACM‑NBCM, CDCES, CHPN‑HPCC, CMGT‑BC, CM‑ABOHN, CMCN, ANCC‑NCM, CMC‑NACCM, COHN, COHN/CM, or CPHRM Knowledge and Abilities Demonstrates skills and competencies necessary to safely perform the job, based on ongoing assessments and performance evaluations. Proficient in speaking, reading, and writing English, especially for activities impacting patient or employee safety or security. Effectively communicates with patients, physicians, family members, and co‑workers with a customer‑service focus and positive language principles. Works independently and exercises sound judgment in interactions with physicians, payors, and patients and their families. Strong assessment, organizational and problem‑solving skills, 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. 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). Houston Methodist is an Equal Opportunity Employer. #J-18808-Ljbffr Houston Methodist