Job Description

Job SummaryJOB SUMMARY
At Houston Methodist, the Case Manager (CM) I position is a licensed registered nurse (RN) who comprehensively plans for case management of a targeted patient population on a designated unit(s). This position works with the physicians and interprofessional health care team to facilitate and maintain compassionate, efficient, quality care and achievement of desired treatment outcomes. The CM I holds joint accountability with social worker for discharge planning and continuity of care and assures that admission and continued stay are medically necessary, communicating clinical information to payors to ensure reimbursement.

Requirements:

PRIMARY JOB RESPONSIBILITIES
Job responsibilities labeled EF capture those duties that are essential functions of the job.

PEOPLE - 15%
1. Communicates in an active, positive and effective manner to all health care team members and reports pertinent patient care and family data in a comprehensive and unbiased manner, listens and responds to the ideas of others. (EF)
2. Collaborates with staff from the interprofessional health care team concerning safety data to improve outcomes and the safe transition of care through effective patient handoffs and uses a structured format for regular communication with patients and families. (EF)

SERVICE - 25%
1. Assesses all patients timely and thoroughly. Participates in daily Care Coordination Rounds, and identifies, communicates barriers to efficient patient throughput. (EF)
2. Facilitates discharge planning activities for assigned patients and collaborates with the social worker and other members of the interprofessional health care team, as well as patient and family, on complex discharges. Maintains ownership of the discharge planning process on assigned units. (EF)
3. Initiates and facilitates referrals for home health care, hospice, and durable medical equipment. Consults with Social Worker to assess psychosocial needs associated with transition to alternative levels of care, ensuring discharge disposition is to the appropriate level. Facilitates transfers. (EF)
4. Supports patients and families in preventing/resolving clinical or ethical issues. (EF)

QUALITY/SAFETY - 25 %
1. Modifies care based on continuous evaluation of the patient's condition, demonstrates clinical problem-solving and critical thinking, and makes decisions using evidence-based analytical approach. Documents assessment and interventions efficiently and effectively. (EF)
2. Plans for routine discharge and elevates emergent situations. (EF)
3. Manages usual patient assignment and other unit demands, completes responsibilities in timely manner with accurate documentation, organizes multiple priorities and anticipates/plans for potential problems. (EF)
4. Focuses on discharge domain by contributing to departmental targets for quality and safety measures on scorecard. (EF)

FINANCE - 25%
1. Contributes to meeting departmental financial target on scorecard, with focus on length of stay. (EF)
2. Performs review for medical necessity of admission, continued stay and resource use, appropriate level of care and program compliance using InterQual Hospital Severity of Illness and Intensity of Service Criteria or Milliman Care Guidelines. Manages assigned patients in Observation Status, daily, informing physicians of timely disposition options to assure maximum benefits for patients and reimbursement for the hospital. (EF)
3. Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay (EF)

GROWTH/INNOVATION - 10%
1. Identifies and presents areas for improvement in patient care or department operations and offers solutions by participating in unit projects and activities. (EF)
2. Identifies areas for improvement based on understanding of evidence-based practice literature. Initiates evidence-based practice/performance improvement projects based on these observations. (EF)

This job description is not intended to be all inclusive; the employee will also perform other reasonably related business/job duties as assigned. Houston Methodist reserves the right to revise job duties and responsibilities as the need arises.

Qualifications:

EDUCATION REQUIREMENTS
* Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certificates, Licenses and Registrations section
* Bachelor's degree preferred

EXPERIENCE REQUIREMENTS
* Three (3) years hospital nursing clinical experience
* Case management experience preferred

CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
* Texas RN license or temporary TX RN license, should obtain permanent license within 90 days. Compact license acceptable according to current Board of Nursing requirements.