Case Manager RN - PRN

PATIENT AGE GROUP(S) AND POPULATION(S) SERVED
Refer to departmental Scope of Service and Provision of Care plans as applicable for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional ethical physical and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth dignity and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET Managing Up Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees experiential journeys to ensure strong communication ease of access to information and a seamless experience

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Actively supports the organizations vision fulfills the mission and abides by the I CARE values

• Collaborates with the physician and all members of the interprofessional health care team to facilitate care for designated case load; monitors the patients progress intervening as needed to ensure that the plan of care and services provided are patientfocused high quality efficient and costeffective; facilitates timely:
  completion and reporting of diagnostic testing;
  completion of treatment plan and discharge plan;
  modification of plan of care as necessary to meet the ongoing needs of the patient;
  assignment of appropriate levels of care;
  completion of all required documentation in EPIC and MIDAS

• Serves as a preceptor as appropriate and implements staff education specific to patient populations and unit processes; coaches and mentors other staff and students. Serves a resource for case management and social work resources and needs for the department and the hospital.

• Performs review for medical necessity of admission continued stay and resource use appropriate level of care and program compliance. Identifies when services no longer meet InterQual/Millman l criteria initiates discussion with attending physicians coordinates with the external case manager to facilitate discharge planning seeks assistance from the physician advisor if needed and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Noncoverage.

• Applies approved utilization criteria to monitor appropriateness of admissions level of care resource utilization and continued stay. Reviews level of care denials to identify trends and collaborate with team to recommend opportunities for process improvement.

• Documents assessment and interventions efficiently and effectively.

• Plans for routine/difficult discharge and anticipates/prevents and manages emergent situations. Specific focus given to discharge plan and elimination of barriers.

• Performs postdischarge review by analyzing the inpatient record to ensure that compliance with quality indicators are met. Intervenes and takes appropriate action to foster realtime compliance with CMS guidelines and other performance measures associated with certification programs and other regulatory national regional or locally sponsored quality programs. Provides reports as needed to appropriate parties showing:
  compliance with established governmental and/or institutional rules and regulations
  analysis of problematic areas and
  actions taken to improve compliance

• Conducts chart audits and performs peertopeer evaluations for continuous quality improvement.

• Identifies opportunities to improve patient satisfaction with focus on discharge domain and collaborates with unit leadership to implement evidencebased patient engagement strategies.

• Monitors Length of Stay (LOS) for case load on an ongoing basis. Identifies population and/or servicespecific trends impacting LOS and addresses/resolves problems impeding treatment progress. Proactively takes action to achieve continuous improvement and expedite care/facilitate discharge. Contributes to meeting departmental financial target on scorecard

• Manages all patients in Observation Status daily informing physicians of timely disposition options to assure maximum benefits for patients and reimbursement for the hospital.

• Secures reimbursement for hospital services by communicating medical information required by all external review entities managed care contracts insurers fiscal intermediaries and state and federal agencies. Responds to requests for information monitors covered days and initiates review to assure that all days are covered and reimbursable.

• Provides education to unitbased physicians nurses and other healthcare providers on any case management topics.

• Identifies opportunity for practice changes. Offers innovative solutions through evidencebased practice/performance improvement projects and shared governance activities.

• Identifies and presents areas for innovation efficiency and improvement in case management or department operations using evidencebased practice literature. Completes and updates the individual development plan (IDP) on an ongoing basis.

• Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certificates Licenses and Registrations section.

• Three 3 years hospital clinical nursing experience which includes two 2 years in case management

• RN Registered Nurse Texas State Licensure and/or Compact State Licensure within 60 days OR
• RNTemp Registered Nurse Temporary State Licensure within 60 days

• Demonstrates the skills and competencies necessary to safely perform the assigned job determined through ongoing skills competency assessments and performance evaluations.

• Sufficient proficiency in speaking reading and writing the English language necessary to perform the essential functions of this job especially with regard to activities impacting patient or employee safety or security.

• Ability to effectively communicate with patients physicians family members and coworkers in a manner consistent with a customer service focus and application of positive language principles.

• Strong assessment organizational and problemsolving skill as evidenced by capacity to prioritize multiple tasks and role components

• Knowledge of Medicare Medicaid and Managed Care requirements

• Comprehensive knowledge of community resources health care financial and payer requirements/issues and eligibility for state local and federal programs

• Comprehensive knowledge of discharge planning utilization management case management performance improvement and managed care reimbursement.

• Understanding of preacute and postacute venues of care and postacute community resources.

• Ability to work independently

• Strong assessment organizational and problemsolving skill as evidenced by capacity to prioritize multiple tasks and role components

• Demonstrates critical thinking and makes decisions using evidencebased analytical approach in interactions with physicians payors and patients and their families

• Well versed in computer skills of the entire Microsoft Office Suite (Access Excel Outlook PowerPoint and Word)

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform No
• Scrubs No
• Business professional Yes
• Other (department approved) No

ONCALL*
*Note that employees may be required to be oncall during emergencies (ie. DIsaster Severe Weather Events etc) regardless of selection below.

• On Call* Yes

TRAVEL**
**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area Yes
• May require travel outside Houston Metropolitan area No

Houston Methodist The Woodlands opened in 2017 as the eighth hospital in the Houston Methodist system. This 187bed 470000squarefoot fullservice acute care hospital offers many of the same services as our flagship hospital in the Texas Medical Center. Also on the $380 million hospital campus located at the intersection of I45 and TX 242 is a medical office building which opened in 2016. Medical Office Building 1 includes a breast care center cancer center & infusion center orthopedics & sports medicine rehabilitation services wellness services and an outpatient laboratory in addition to multispecialty physician practices. A second medical office building and 785car parking garage opened in 2018.