Case Management Coordinator - Days

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

• Role models as a preceptor and implements staff education specific to patient populations and unit processes; coaches and mentors other staff. Functions a resource for case management and social work resources and needs for the department and the hospital. Exemplifies/leads teamwork by responding positively to requests for assistance. Fosters staff engagement by demonstrating active listening requesting and acknowledging feedback making equitable decisions providing rationale when appropriate and supporting organizational.

• Arranges expedites and completes acquisition of post-acute care needs or secures insurance authorization as directed confirming with social workers and case managers and ancillary departments based on physician orders payor/reimbursement practices and regulations that may impact the patients plan of care.

• Facilitates designing and redesigning of CM representative processes and workflow. Actively participates in making recommendations for improving working relationships in the department hospital vendors and post-acute providers. Leads contributions with leadership to identify workflow opportunities assisting with recruitment and retention efforts including to improve employee engagement department scores for CM representatives through peer-to-peer accountability.

• Provides necessary transfer/admission documentation. Reviews for accuracy and completion. Supports clerical and clinical functions for patients physicians and staff. Provides administrative assistance as needed including scheduling follow-up appointments or providing clinical updates to payors as needed Initiates efficiency initiatives for durable medical delivery process.

• Provides front-line problem resolution to straightforward questions or customer service needs. Provides guidance to payors/ancillary partners and/or CM Representatives on service standards and service recovery. Partners with leadership to implement best practices to deliver unparalleled service.

• Tracks and trends service failures. Articulates and takes action for service gaps to leadership and along with recommendations for improvement. Collaborates with the leadership team to develop strategies to maximize efficiency and remove barriers to ensure effectiveness of post-acute care referrals or minimize denials or delays.

• Participates in action plans for transition of care/discharge questions for patient satisfaction. Identifies opportunities to improve the customer experience. Contributes towards improving department scores for patient satisfaction on unit-based scorecard through peer-to-peer accountability.

• Serves as a role models for situational awareness using teachable moments to improve safety. Contributes to identification of corrective action and improvement activities to meet department and hospital targets for quality and safety collaborating with the interprofessional health care team.

• Collaborates with the leadership team to develop opportunities to improve documentation of insurance correspondence and compliance with payors/appeals distribution of regulatory notices including the CMS Important Message from Medicare Medicare Outpatient Observation Notice etc.

• Proactively secures reimbursement/certification and authorization-related needs independently and escalates to management if needed. 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 and post-acute care needs.

• Streamlines concurrent insurance denials and/or appeals process in collaboration with management and nursing staff. Develops and implements best practices to ensure timely and accurate EMR documentation of authorization approvals and denials and recommends strategies for improvement.

• Identifies trends by payor and reports findings to management for further. Provides information to patients/families on insurance/managed care benefits and assesses need for further education by social worker/case manager.

• Self-motivated to independently manage time effectively and prioritize daily tasks. Provides input into the department resource utilization including capital and operational budget needs as appropriate. Collaborates with the leadership team to determine cost-reduction strategies. Contributes towards department financial targets through timely documentation minimizing incidental overtime optimizing efficiency and other areas according to department specifications.

• Shares knowledge with CM Representatives 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.

• Offers innovative solutions through participation in department projects and shared governance activities. Ensures own career discussions occur with appropriate management. Completes and updates the My Development Plan on an on-going basis.

• Associates degree or two additional years of experience in lieu of degree

• Five years experience in service recovery insurance case management or business office-related area three of which must be in case management

• Previous experience in Case Management post-acute setting or physician practice

• 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

• Strong knowledge of community resources

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

• Adapts to multiple ongoing priorities with minimal supervision including but not limited to organizing workflows and actively participating in problem-solving

• Demonstrates ability to access information both in the department and within the hospital system to support the department and interprofessional health care team as appropriate

• Possesses expert computer knowledge including electronic health records i.e. Epic Microsoft Office (Word PowerPoint & Excel) to maintain patient information

• Strong knowledge of Medical Terminology

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

• Must be able to learn new skills effectively

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

Houston Methodist The Woodlands opened in 2017 as the eighth hospital in the Houston Methodist system. This 187-bed 470000-square-foot full-service 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 I-45 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 multi-specialty physician practices. A second medical office building and 785-car parking garage opened in 2018.