Case Management Rep

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

• Serves as a department resource for questions related to case management activities. Communicates in an active positive and effective manner to all interprofessional health care team members. Reports pertinent patient care and family data in a comprehensive and unbiased manner. Performs phone call and communication triage troubleshoots and routes issues to appropriate individuals assists in resolution of non-clinical issues as needed

• Facilitates and arranges acquisition of post-acute needs as directed and in collaboration with the clinical team. Follows payor/reimbursement practices and regulations that may impact the patients plan of care

• Provides appropriate and timely communication update and documentation to the referring personnel to keep them informed of the status of the request

• Contributes towards improvement of department scores for employee engagement i.e. peer-to-peer accountability.

• Assists the department in distributing required notices including the Medicare Notice of Discharge to patients securing signatures on the form from the patient or their legal representative and answering questions regarding the appeal process

• Distributes the Medicare Notice of Discharges to identified patients including capturing patient and their legal representatives signatures answering any questions regarding the appeal process

• Coordinates with the clinical staff to prioritize placement requests. Provides necessary documentation to facilitate post-acute services

• Assists with clerical and clinical functions for patients physicians and staff. Provides administrative support as needed including scheduling follow-up appointments and confirming the provision or delivery or post-acute services or equipment

• Participates in quality improvement initiatives and collects data for use in department performance improvement as directed. Maintains timelines for follow up and prioritization of department projects and tasks

• Updates and maintains resources information and database or directories elated to post-acute providers and insurance contacts to facilitate timely communication and coordination as needed

• Informs social worker/case manager of the patients available benefits through insurance/managed care provider. Assists in providing community resources/services to uninsured patients as requested Case Management staff

• Participates in reimbursement/certification and authorization-related activities as directed. Documents approvals and authorization numbers from payors. Logs communications and provides information to social workers and case managers business office/patient access etc. on insurance/managed care benefits

• Supports and assists with concurrent insurance denials and appeals process transmission of utilization reviews to insurance companies coordination of peer discussions as directed by the clinical team. Documents authorization approvals and denials

• Maintains awareness of payor/reimbursement practices and regulations that may impact patients plan of care and confers with care coordinators and social workers to prioritize placement requests

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

• High School diploma or equivalent education (examples include: GED verification of homeschool equivalency partial or full completion of post-secondary education etc.)

• Associate degree preferred

• Two years of experience in any of the following: service recovery insurance verification working with patient information having patient contact and/or general health care coordination responsibilities within a healthcare environment

• Previous experience in hospital setting and/or Case Management

• N/A

• Demonstrates the skills and competencies necessary to safely perform the assigned job determined through on-going 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 co-workers in a manner consistent with a customer service focus and application of positive language principles

• Some knowledge of community resources

• Must be able to operate within a Microsoft Office environment. Proficiency in MS Outlook and MS Word/Excel knowledge of Medical Terminology

• Excellent telephone oral and written communication skills time management and prioritization skills

• Able to learn new skills effectively

• Ability to work independently while collaborating with other team members and exercise sound judgment in interactions with physicians payors and patients and their families

• Strong organizational and problem-solving skills

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

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

ON-CALL*
*Note that employees may be required to be on-call during emergencies (ie. DIsaster Severe Weather Events etc) regardless of selection below.

• On Call* No

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

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

Since its founding in 1919 Houston Methodist Hospital has earned worldwide recognition. Houston Methodist Hospital is affiliated with the Weill Medical College of Cornell University and New York-Presbyterian Hospital one of the nations leading centers for medical education and research. In 2020 U.S. News & World ReportnamedHouston Methodist Hospitalto its top ranked Honor Roll for the fourth time and second consecutive year. 2020 also marked the ninth year in a row Houston Methodist Hospital has been named the No. 1 hospital in Texas. Houston Methodist Hospital directs millions of research dollars into patient care and offers the latest innovations in medical surgical and diagnostic techniques. With 952 operating beds 85 operating rooms and over 8000 employees Houston Methodist offers complete care for patients from around the world.

The same high-quality care for which Houston Methodist is known is available at several Emergency Care Centers in Houston and the surrounding areas. These Emergency Care Centers house exam rooms full digital radiography suite low radiation dose 16-slice CT scan ultrasound and a full on-site stat chemistry lab.