JOB SUMMARY

At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN) responsible for comprehensively planning for case management, which includes care transitions and discharge planning of a targeted patient population on a designated unit(s) and / or service lines.

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 position holds joint accountability with the 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 - 20%

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)

Collaborates with staff from the interprofessional health care team concerning safety data to improve outcomes and the safe transition of care.

Uses a structured format for regular communication with patients and families. (EF)

Conducts self in a manner that is congruent with cultural diversity, equity and inclusion principles. Contributes towards improvement of department scores for employee engagement, i.

e. peer-to-peer accountability. (EF)

SERVICE - 25%

Assesses all patients timely and thoroughly. Participates in daily Care Coordination Rounds (CCR), and identifies, communicates barriers to efficient patient throughput.

Supports patients and families in preventing / resolving clinical or ethical issues. (EF)

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)

Initiates and facilitates referrals for home health care, hospice, and durable medical equipment. Consults with Social Worker Case Manager to assess psychosocial needs associated with transition to alternative levels of care, ensuring discharge disposition is to the appropriate level.

Facilitates transfers. (EF)

QUALITY / SAFETY - 20%

Modifies care based on continuous evaluation of the patients condition, demonstrates clinical problem-solving and critical thinking, and makes decisions using evidence-based analytical approach.

Documents accurate assessment and interventions efficiently and effectively. (EF)

• Plans for routine discharge and elevates emergent situations. Manages usual patient assignment and other unit demands and anticipates / plans for potential problems. (EF)
• Focuses on discharge domain by contributing to department and hospital targets for quality, patient satisfaction and safety measures. (EF)

FINANCE - 25%

Performs review for medical necessity of admission, continued stay and resource use, appropriate level of care and program compliance using nationally recognized screening 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)

• Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay. (EF)
• Participates in denial mitigation activities to ensure appropriate reimbursement for services rendered. (EF)
• Contributes to meeting department and hospital financial target, with focus on length of stay. Utilizes resources with cost effectiveness and value creation in mind.

Self-motivated to independently manage time effectively and prioritize daily tasks, assisting coworkers as needed. (EF)

GROWTH / INNOVATION - 10%

• Identifies areas for improvement based on understanding of evidence-based practice literature. Initiates evidence-based practice / performance improvement projects based on these observations and offers solutions by participating in unit projects and activities. (EF)
• 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. (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

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

o Bachelors degree preferred

EXPERIENCE REQUIREMENTS

o Three years hospital nursing clinical experience

o Case management experience preferred

CERTIFICATIONS, LICENSES AND REGISTRATIONS REQUIREDo 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. KNOWLEDGE, SKILLS AND ABILITIES REQUIREDo Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluationso 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 securityo 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 principleso Knowledge of Medicare, Medicaid and Managed Care requirementso Progressive knowledge of community resources, health care financial and payor requirements / issues, and eligibility for state, local and federal programso Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursemento Understanding of pre-acute and post-acute venues of care and post-acute community resourceso Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their familieso Well versed in computer skills of the entire Microsoft Office Suite (Excel, Outlook, PowerPoint and Word)o Strong assessment, organizational and problem-solving skill

Case Manager

$15.00 - $16.41 hrly

Looking for rewarding work in an organization dedicated to making a positive impact in the lives of others? Bring your clinical and interpersonal skills to a team-based workplace that puts people first.

As the Case Manager, you will provide services in residential, vocational, or in-home settings, providing invaluable support to the individuals you serve.

• Ensure that support plans and services adhere to Individual Plans, quality standards, and regulatory requirements.
• Complete structured assessment interviews with parents / care providers.
• Conduct observation of the individual in appropriate settings such as home, school, or community.
• Review social history information, complete functional assessments, and target appropriate behavior baseline information for each referred individual.
• Write and submit a summary of assessment and recommended behavior support plan components to interdisciplinary team (IDT) or operations leader, as applicable.
• Advocate for the human and civil rights of individuals receiving services from the agency by attending and presenting behavior support plan information to review committees.
• Document progress and activity; review records and logs to stay abreast of changes in service plans; maintain confidentiality;

complete billing documentation as applicable; organize and record all documentation in an accurate and timely manner.

• Maintain healthy and professional relationships with individuals, friends, families, guardians, and case managers; implement the company’s Customer Service Standards.
• Report any instance of alleged abuse or neglect according to internal and external standards; report medical, behavioral, and other incidents following company policy and external requirements.
• Maintain confidentiality and respect the rights of individuals according to applicable bill of rights; practice universal precautions;

assist individuals in exercising their rights.

Support and train staff in implementing Individual Support Plans (i.e. : behavior intervention plans) and conduct classes and orientations as assigned.

Attend staff meetings and interdisciplinary team meetings as needed.

• Assist with socialization and behavioral development, personal care, housekeeping, recreational activities, transportation, community orientation, shopping, financial management, citizenship, and other activities of daily living as needed.
• May accompany individuals to medical appointments; relay instructions and information to and from medical providers as required.
• If assigned, accurately administer and document delivery of medications and treatments; promptly report administration errors;

maintain appropriate security of controlled medications and other medications and supplies.

If assigned, monitor individual’s health, documenting concerns and communicating with nurse or supervisor as appropriate;

follow individual health care directives.

May transport individuals into the community; drive safely and according to local laws; assure proper use of safety equipment including seat belts, lifts, and wheelchair ties;

report accidents and safety concerns to appropriate authorities, supervisor, or maintenance personnel immediately.

• Check water temperature as required when assisting with bathing; participate in safety drills and protect persons being served in the event of emergency.
• Comply with all established safety policies, procedures, and rules; report unsafe hazards to supervisor and participate in safety-related training or activities.

Qualifications :

• Bachelor’s Degree in a human services field.
• Two years of related experience.
• Training in behavior modification techniques and / or experience providing behavior management treatment as required by state or program funder.
• Knowledge of specialized populations such as individuals with a developmental disability, brain injury, or mental health;

expertise in special disciplines such as behavioral support, early intervention, or crisis intervention.

• Reliable, responsible, and caring nature with ability to work well with others.
• Commitment to the company’s mission and values.
• Current driver’s license, car registration and auto insurance if providing transportation for individuals receiving services.
• All state-required training and certification completed in mandated timeframes.

Why Join Us?

• Pay on Demand, Full compensation / benefits package for employees working 30+ hours / week.
• 401(k) with company match.
• Paid time off and holiday pay.
• Rewarding, hands-on work with plenty of variety no two days are ever the same!
• Make a lasting impact in the lives of individuals!
• Enjoy job security with nationwide career development and advancement opportunities.

The mission of The University of Texas MD Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.

The primary purpose of the Case Manager position is to :

Develop an individualized plan of care by assessing, planning, facilitating and advocating for healthcare needs along the continuum of care to achieve optimal clinical, financial and operational outcomes.

Coordinates with the Multidisciplinary Care Team and internal / external customers in the management of patient care. The role integrates and coordinates utilization management concepts, care facilitations, and discharge planning functions.

Standards of Practice - Care Coordination

• Serves as the liaison between internal and external team members regarding issues related to utilization management and / or coordination of care
• Facilitates the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement
• Identify payer related issues that may impact the continuity of care such as those patients with out of network insurance or those who may be underinsured
• Demonstrates ability to work independently and exercise sound judgment in interactions with physicians, members of the interdisciplinary team, internal and external customers, patients and their families
• Demonstrates excellent interpersonal communication and negotiation skills
• Demonstrates strong organizational and time management skills as evidenced by ability to prioritize and manage multiple tasks and role components
• Seeks consultation from appropriate disciplines as requested to expedite patient care and facilitate discharge
• Modifies patient plan of care and documents as required to meet the ongoing needs of the patient
• Communicates plan of care to the patient / family and members of interdisciplinary team and documents to assure continuity of care
• Works collaboratively and maintains communication with physicians, nursing and other members of the interdisciplinary team to demonstrate effective, timely and appropriate patient care management and eliminate barriers to efficient delivery of care in the appropriate setting
• Responds to all consults in a timely manner
• Adheres to all departmental guidelines and polices that surround care coordination
• Work collaboratively with providers and medical team to ensure adequate documentation to support medical necessity of inpatient stay and level of care determinations

Discharge Planning

• The Case Manager is responsible for the oversight of Continuum of Care Planning for post hospital acute care services, including but not limited to, completion and facilitation of referrals and or transfers.
• Participates in and / or conducts daily inpatient rounds with members of the Interdisciplinary team of assigned units and twice a week in assigned outpatient clinics.
• Maintains visibility on assigned units and interacts with Clinical Care Team, patients and families
• Meets and discusses all assigned patients daily with Clinical Nurse Leader or designee
• Participates daily in multidisciplinary inpatient rounds with physician and / or designee
• Issues second IM Notice, Moon Notice, and Condition Code 44 notification and documents in OneConnect prior to discharge, as appropriate
• Responds to Patient Needs Assessment, documents interventions, and clears from list within one business day
• Responds timely to requests to coordinate discharge services for unplanned discharges
• Communicates, both verbally and in writing, all Case Management interventions regarding discharge plan
• Maintains knowledge of available post-acute care services based on payer coverage guidelines
• Completes ACMA Compass training annually

Documentation

• Documents daily Case Management activities appropriately in EPIC to reflect interventions prior to the close of business day
• Documents all discharge planning activities in EPIC as needed or at a minimum weekly to include identified case management issues and progress towards discharge
• Utilizes handoff tools in EPIC
• Activates out of office notification on e-mail and voice mail with appropriate information prior to scheduled day off
• Signs in as Case Manager on all assigned patients
• Demonstrates compliance with all state and federal regulatory requirements
• Facilitates authorizations for Rehabilitation transfers and ensures the preadmission Rehabilitation MCG (Milliman) review is completed prior to transfer to the Inpatient Rehabilitation Service.
• Documents in EPIC the discharge care coordination information including name of agency with contact number, services to be provided and date and time services to start if applicable,

Other duties as assigned

Education Required : Associate's degree in nursing (ADN).

Experience Required : Three years of experience as a Registered Nurse coordinating care for high risk and complex patients.

Licensure / Certification Required : Current State of Texas Professional Nursing License (RN). American Heart Association Basic Life Support (BLS).

It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity / expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law.

The Case Manager is responsible for directing and coordinating the functions and activities of health care services delivery and discharge planning with the multidisciplinary team.

The Case Manager facilitates communication and coordination between the health care team members involving both the resident and family in the decision-making process.

Activities include encouraging appropriate use of health care services and striving to improve quality of care and maintain cost-effectiveness on a case-by-case basis.

The Case Manager is responsible for establishing a positive relationship with payer sources and initiating necessary documentation for re-authorization of the resident's continued stay.

JOB SPECIFIC RESPONSIBILITIES :

• Assembles treatment team to conduct admissions conference with patient and / or support persons.
• Assures a secure and comforting welcome to patient / support person upon admission.
• Upon patient admission, contact external payor source case manager / representative of the patient's actual admission and reviews schedule for clinical updates.
• Completes admission forms as required on each assigned patient.
• Uses admission profile information to prepare for discharge planning and updates profile as patient / family context changes.
• Liaisons with patient's attending physicians and medical staff to ensure patient's medical needs are met.
• Liaisons with treatment team members to ensure patient's treatment is accurately focused on patient needs.
• Coordinates with medical staff to attend weekly team rounds and arrange for diagnostics, equipment, supplies, or medicals services as ordered.
• Completes Clinical Pre-assessments on patients as needed.
• Provides input to the Administrator regarding Case Management issues.
• Provides third-party payor sources with appropriate clinical updates as per the agreed-upon reporting schedule.
• Presents a positive and helpful working relationship with all external case managers / representatives and community agencies, demonstrating effective internal case management.
• Acquires appropriate information to address payor denials necessary to receive payment due.
• Maintain initial and ongoing documentation in the medical record regarding patient status related to treatment progress, family issues, estimated length of stay, and discharge needs.
• Arranges proper and timely discharge planning for all patients in coordination with family or support persons.
• Coordinates input and feedback from a multidisciplinary team, patient's family, or support persons for discharge needs from admission to actual discharge.
• Acquires necessary community resources to meet the patient's needs before discharge.
• Coordinates discharge with patient's payer sources and community services to ensure a safe, timely, and effective discharge is achieved.
• Verifies community services have been arranged to ensure a timely and uninterrupted discharge transition of a patient is to the most appropriate setting.
• Resolves patient family or support person's complaints or concerns to appropriate team members and follows up to ensure resolutions are acceptable to all parties.
• Exhibits a positive professional demeanor to residents and relevant parties, offering constructive communication, cooperation, and assistance to ensure a satisfactory patient stay of treatment.
• Provides effective assistance and positive relations with co-workers that demonstrate collaborative multidisciplinary treatment team approach to resident or program problem-solving issues.
• Provides timely information / feedback to the designated supervisor on any resident / family / support person / payor source relevant issue that could jeopardize the patient's treatment, family / support person / payor sources, or discharge planning issue.
• Communicates with the manager and department directors to ensure team-focused patient-centered care.
• Performs other duties as assigned.

POSITION QUALIFICATIONS :

EDUCATION :

Bachelor's Degree in health care field preferred

EXPERIENCE :

• Experience in pediatric case management
• Strong background in healthcare
• 3-5 years direct pediatric patient care experience

LICENSURE / CERTIFICATION :

• Current license as a Registered Nurse or Social Worker in the state of Texas.
• Current AHA BLS certification.

No Experience Required

Requirements :

Bilingual (Spanish / English)

AK Law Firm (AK) is a growing personal injury law firm, has an exciting full-time employment opportunity for a Case Manager in our Houston office.

Here at AK Law Firm, we are redefining the work environment culture of personal injury law firms. We value our clients as well as valuing and appreciating our employees.

We offer great compensation, a rich benefit package (firm pays for 90%-100% of benefits) and a thriving work culture.

We are looking for people with the right abilities (and not just work history) so we can train you to be the best within our industry.

For this reason, experience is not needed as long as you have the right skills to come in, work hard and improve every day.

This job is for someone who wants to better their life by challenging themselves every day.

Overall Duties and Responsibilities will include, but are not limited to :

• Responsible for completing weekly client calls to check in with clients and confirm treatment is occurring.
• Perform initial client calls within 24 hours of case assignment.
• Will be responsible for managing the treatment of up to 100 clients.
• Assist clients in finding medical providers.
• Follow up proactively with medical providers as needed to confirm clients are receiving appropriate treatment.
• Maintain your client's file completely, including continually updating all relevant sections of the digital file.
• Follow all established standard operating procedures to prompt leadership (as necessary) for decisions and instructions to maneuver cases through phases appropriately.
• Arranging transport (Uber) to and from treatment, as needed, for clients.
• Respond to all emails in a timely manner.
• Responsible for proactively communicating any provider issues with Supervisor.

Salary

Salary is negotiable based on skills - however, base is a minimum of $20.00 / hour with potential for rapid salary increases based on performance

Benefits :

• Dental insurance
• Employee assistance program
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Referral program
• Vision insurance

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