Certified Case Manager Weekends

**This is a fulltime position covering weekends**

At Houston Methodist the Case Manager (CM) Certified position is a registered nurse (RN) responsible for comprehensively planning for case management of a targeted patient population on a designated unit(s) and/or service line. This position works with the physicians and interprofessional healthcare team to facilitate and maintain compassionate efficient quality care and achievement of desired treatment outcomes. The CM Certified position holds joint accountability with social workers 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. In addition to performing the duties of a CM this position helps drive change by identifying areas where performance improvement is needed e.g. daytoday workflow education process improvements patient satisfaction.

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 healthcare team to facilitate care for designated assignment; monitors the patients progress intervening as needed to ensure that the plan of care and services provided are patientfocused high quality efficient and costeffective.

• Serves as a preceptor and implements staff education specific to patient populations and unit processes; coaches and mentors other staff and students. Serves a resource for department and hospital. Provides education to physicians nurses and other healthcare providers on case management topics.

• Initiates contributions towards improvement of department scores for employee engagement i.e. peertopeer accountability.

• 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/Milliman 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.

• Plans for routine/difficult discharge and anticipates/prevents and manages emergent situations. Facilitates timely:
  Assessment and intervention to prevent or reduce readmission
  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 designated EMR and applications or programs
  elimination of discharge barriers

• Documents assessment and interventions efficiently and effectively. Proactively takes action to achieve continuous improvement and expedite care/facilitate discharge.

• 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 assigned cases on an ongoing basis. Identifies population and/or servicespecific trends impacting LOS and addresses/resolves problems impeding treatment progress. Contributes to meeting department and hospital financial targets with focus on length of stay.

• Manages all patients in Observation Status 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 state and federal agencies. Responds to requests for information monitors covered days initiates review to assure that all days are covered and reimbursable.

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

• Seeks opportunities to identify selfdevelopment needs and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates the My Development Plan on an ongoing basis.

• Bachelors degree or higher in nursing

• Masters degree preferred

• Five years hospital clinical nursing experience which includes two years in case management

• Health ServicesRN Registered Nurse Texas State Licensure and/or Compact State Licensure within 60 days OR
• Health ServicesRNTemp Registered Nurse Temporary State Licensure within 60 days AND
• Health ServicesMagnet ANCC Recognized Certification Case Managementrelated OR
• ACM Accredited Case Manager (NBCM) National Board for Case Management

• 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

• Comprehensive knowledge of Medicare Medicaid and Managed Care requirements

• Comprehensive knowledge of community resources health care financial and payor 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

• Competent 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 Cypress Hospital scheduled to open in the first quarter of 2025 will be Houston Methodists ninth hospital and will incorporate the most advanced technology available from the day the doors open. With 100 beds (at our opening; licensed for 276 and a prime location in the heart of the rapidly growing U.S. 290 corridor the hospital will be equipped with technologically advanced innovations implemented during COVID many of them designed to make patient communication with physicians staff and families the very best and most effective in any health care facility. Even though the hospital wont be fully operational until 2025 we have several services and specialties opening in 2024.