Description

Minimum Qualification

Education : Graduate of an accredited school of professional nursing required; Bachelors of Nursing preferred; or graduate of an accredited Masters of Social Work program (MSW);

Master’s degree preferred.

Licenses / Certifications :

• Current and valid license to practice as a Registered Nurse in the state of Texas or
• Current and valid license as a Master Social Worker (LMSW) in the state of Texas required, LCSW preferred.
• Certification in Case Management required within two (2) years of hire into the Case Manager position.

Experience / Knowledge / Skills :

• Three (3) years of experience in hospital-based nursing or social work.
• Experience in utilization management, case management, discharge planning or other cost / quality management program preferred.
• Excellent interpersonal communication and negotiation skills.
• Demonstrated leadership skills.
• Strong analytical, data management and PC skills.
• Current working knowledge of discharge planning, utilization management, case management, performance improvement, disease or population management and managed care reimbursement.
• Understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre and post acute care.
• Demonstrated understanding of motivational interviewing and change management.
• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families.
• Effective oral and written communication skills.

Principal Accountabilities

• Coordinates / facilitates patient care progression throughout the continuum.
• Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient care.
• Addresses / resolves system problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge.
• Seeks consultation from appropriate disciplines / departments as required to expedite care and facilitate discharge.
• Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load;
• monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective;
• facilitates the following on a timely basis : completion and reporting diagnostic testing; completion of treatment plan and discharge plan;
• modification of plan of care, as necessary, to meet the ongoing needs of the patient; communication to third party payors and other relevant information to the care team;

assignment of appropriate levels of care; completion of all required documentation in TQ screens and patient records.

Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning).

Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.

Leads the development, implementation, evaluation and revision of clinical pathways and other Case management tools as a member of the clinical resource / team.

Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators (e.

g., readmission rates, unplanned return to OR, etc.).

• Acts as preceptor / mentor to new hires. Assists in development of orientation schedule and helps identify individual needs for learning.
• Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
• Completes Utilization Management and Quality Screening for assigned patients.
• Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on department standards.
• Identifies at-risk populations using approved screening tool and follows established reporting procedures.
• Monitors LOS and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.
• Refers cases and issues to Care Management Medical Director in compliance with department procedures and follows up as indicated.
• Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients. Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.
• Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.
• Ensures that all elements critical to the plan of care have been communicated to the patient / family and members of the healthcare team and are documented as necessary to assure continuity of care.
• Manages all aspects of discharge planning for assigned patients.
• Meets directly with patient / family to assess needs and develop an individualized continuing care plan in collaboration with physician.
• Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation.
• Ensures / maintains plan consensus from patient / family, physician and payor.
• Refers appropriate cases for social work intervention based on department criteria.
• Collaborates / communicates with external case managers.
• Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment and supplies.
• Documents relevant discharge planning information in the medical record according to department standards.
• Facilitates transfer to other facilities as appropriate.
• Actively participates in clinical performance improvement activities.
• Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.
• Uses data to drive decisions and plan / implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data.
• Collects, analyzes and addresses variances from the plan of care / care path with physician and / or other members of the healthcare team.

Uses concurrent variance data to drive practice changes and positively impact outcomes.

• Collects delay and other data for specific performance and / or outcome indicators as determined by Director of Outcomes Management.
• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory / continuing education and skills competency;

supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences.

Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.

POSITION SUMMARY / RESPONSIBILITIES

Manages the care coordinators (case managers), home health coordinators and clerical staff to insure a smooth patient flow from preadmission to discharge and follow up in accordance with the patient’s and the payers requirements.

Works with the Manager for Social Services to ensure an interdisciplinary treatment plan of care for patients. Facilitates the delivery of services, evaluates effectiveness, tracks outcomes and functions as the manager of the team.

EDUCATION / EXPERIENCE

Graduation from an accredited college or university with a bachelor's degree in nursing is preferred. Required experience : minimum of two years recent management experience;

three years of hospital clinical nursing experience and one year experience in case management, utilization review or hospital quality assurance.

Experience in each of these areas in a hospital setting is preferred.

LICENSURE / CERTIFICATIONS

Current registration with the Texas State Board of Nurse Examiners and current CPR certification (BLS) is required. Case Manager Certification (CCM or ANCC) is highly desirable.

PI215782604

Description

The Hospital Case Manager (HCM) focuses on concurrent review of GMG MC patients (members) in the hospital and facility setting.

Utilizing nationally recognized care guidelines and the patient’s health plan coverage guidelines, the HCM monitors admissions and continued stays for Medical appropriateness.

The HCM develops a discharge (DC) plan in coordination with the physician(s), the patient and the family to promote a safe and timely discharge.

They act as an advocate for members and their families by linking them to educational resources and community resources to support their aftercare.

Effective utilization management of healthcare resources is a major function of this role.The HCM participates in the Patient Care Committee Meeting (PCC) and other GMG or Case Management (CM) team meetings to optimize care plans, treatment plans and GMG protocols.

DUTIES :

• Round daily on assigned GMG MC Patients in the hospital setting, and at least weekly on those in the SNF setting.
• Utilize nationally recognized care guidelines and the patient’s health plan coverage guidelines to monitor admissions and continued stays for Medical appropriateness.
• Assess the medical, physical, psycho-social and transition needs to anticipate the services, equipment, and follow up care that will be needed upon DC.
• Confer with physician(s), patient, and families in developing the transitional or DC plan.
• Demonstrate knowledge of utilization management, care coordination, and current standards of care as a foundation for transition planning activities.
• Enter timely and accurate information into the EMR to document pertinent patient / family communications, referral authorizations and plans.
• Collaborate effectively with other members of the GMG CM team to clearly communicate regarding coverage determinations, authorizations, and any special follow up needed post DC.
• Communicate regularly with the MC Medical Director on patient status, issues or questions.
• Serve as the clinical liaison with hospital, clinical and administrative staff. Provide information on the clinical authorizations for inpatient / SNF care and milestones achieved toward DC status.
• Attend weekly Patient Care Committee (PCC) as census allows.
• Provide constructive information to patients and families to minimize problems and increase customer satisfaction. Explain and reinforce the physician plan of care.
• Decision-making is usually based on prior practice or policy, with some interpretation. Must apply individual reasoning to the solution of problems.
• Maintain current knowledge of health plan benefits, health plan contracts and preferred provider network.
• With the assistance of other members of the GMG MC teams, guides physicians in their awareness of preferred contracts, providers and facilities.
• Perform Clinical High Risk Home Visits as assigned.
• Maintains strict confidentiality of all PHI; Protects laptop, cell phone, and documents.
• Performs all other related duties as assigned.

EDUCATION, EXPERIENCE & SKILLS :

• Education required : Bachelor’s or Associate’s degree in Nursing
• Current, unrestricted RN license required.
• Four or more years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions in adult and geriatric populations.
• Two or more years of managed care and / or case management experience preferred.
• Able to communicate clearly in both written and verbal format. Strong interpersonal skills.
• Strong organization, planning and decision making skills. Able to think independently to identify problems and define action plan to resolve.
• Proficient with Microsoft Office applications including Word, and Excel.
• Case Management Certification (CCM) preferred.

PREFERRED Language SKILLS :

Bilingual (English / Spanish) language proficiency.

Supervisory Responsibilities :

This job has no supervisory responsibilities.

Work Environment : Depending upon the area assigned, may be 100% clinical setting, office setting in a clinical environment : Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations and other conditions common to a clinic environment.

Physical Demands : Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs.

Close vision and ability to adjust focus.

Qualifications

Skills

Behaviors

Motivations

Education

Preferred

Bachelors or better in Nursing.

Experience

Licenses & Certifications

Required

Registered Nurse

The Case Manager is responsible for long term person-centered case management services from intake to annual reviews. The Case Manager will assist and guide families through complex healthcare systems and assist them in obtaining access to critical services.

Case Manager is assigned to every family in an effort to ensure they receive a unique care plan tailored to the needs of the child and family.

Minimum Qualifications

• Bachelor’s degree or higher in human service field, Education field or social work
• Two years of related experience working in community programs serving children with special health care needs.
• Highly proficient in Microsoft Office Suite
• Bilingual in English and Spanish
• Valid Texas Driver License with acceptable MVR and background check

Typical Duties

• Works alongside team to provide long term and person-centered case management services, including intake, assessment, development and implementation of services.
• Facilitates client interviews in a private setting (home, office, alternate sites) to ensure client privacy and confidentiality.
• Protects confidential information obtained through the course of conducting agency business.
• Effectively utilizes pre-survey to guide the development of the care plan for active cases and post-survey on all cases pending deactivation.
• Establishes care plans including referrals and direct assistance tailored to the needs of the child and family.
• Reviews family service plans on a quarterly / annual basis for all open cases updating progress notes and modifying as needed.
• Remains abreast of available resources on a local, state and national level and utilizes resources appropriately.
• Assists families in obtaining and completing applications for insurance and funding programs including but not limited to CSHCN, SSI, Medicaid waivers, etc.
• Manage client contacts, case files and ClientTrack (database) ensuring timely updates, thorough documentation and accurate information.
• Effectively manage average client caseload designated by program requirements.
• Actively participates in training, community networking and agency training courses relating to resources offered to families in need.
• Follows approval process for expenses incurred.
• Performs other duties, tasks and special projects as assigned.

The above description covers the principal duties and responsibilities of the job. The description shall not, however, be construed as a complete listing of all miscellaneous, incidental or similar duties which may be required from day-to-day.

The candidate selected for employment will be required to submit to a criminal background check, education verification and drug test.

Interested candidates should submit their resume, with salary requirements, via our career portal on our website at www.seekinghr.

com or contact us directly at (210) 679-4879 with any questions.

Equal Employment Opportunity Employer M / F / D / V

If you are passionate about transforming communities with a mission-driven organization, then we have the opportunity for you!

Since 1939, Lutheran Immigration and Refugee Service (LIRS) has offered welcome and hope to refugees. LIRS has transformed lives with the support and hard work of people like you, to welcome the most vulnerable to the United States from sea to shining sea.

We help people seeking safety from persecution in their home countries and reunite families torn apart by conflict. We resettle refugees.

We protect vulnerable children who arrive alone in the United States. We advocate for compassion and justice for all migrants.

Widely recognized for our expertise in implementing federal programs on behalf of refugees and migrants in the United States, conducts policy advocacy, and advances the protection and rights of vulnerable migrants.

Headquartered in the beautiful Inner Harbor of downtown Baltimore we provide services nationwide through a network of staff and affiliates.

Attracting and retaining the best talent is vital to our continued growth and we are proud to offer an excellent benefits package including medical, dental, vision available the first day of employment, professional development, tuition reimbursement, generous paid time off including 20 days of vacation, 12 days of sick leave, 12 paid holidays PLUS the week between Christmas and New Year's Day, 12 weeks of paid parental leave and up to 12 weeks of fully paid FMLA leave, company 403(b) contribution of 3%, an additional 7% match, Family Building benefits for reproductive procedures, adoption / foster care assistance, and an annual wellness benefit that can be customized to support your personal needs including funding enrichment classes, gym memberships, and healthy eating plans (to name a few) all in an inclusive and progressive environment! Lutheran Immigration and Refugee Service is a champion for all uprooted people.

Please join us as we make a difference in the lives of newcomers.

Reporting to the Director for Child and Family Services, the Clinical Case Manager will be responsible for providing casework and supportive services to children and families which includes ensuring the clients are connected to educational services, legal services, health services, job readiness programs, etc.

In addition to casework and supportive services, the Clinical Case Manager will also be responsible for communicating with stakeholders in an effective and timely manner to ensure case continuity.

This position is expected to function effectively with moderate supervision while following the guidelines given on procedures, along with agency, state, and federal regulatory requirements.

DUTIES

• Ensure that all assigned clients on your caseload and under your supervision receive referrals to include but not limited to medical, recreational, educational, and other supportive services in accordance with the time and documentation expectations of the program.
• Develop and completes assessments, service and treatment plans, progress notes, incident reports and any other necessary documentation in a timely manner.
• Create a trusting and safe relationship with the client and encourage personal growth of the client.
• Actively participate in weekly staff meetings with the clinical team and stakeholders.
• Attend, facilitate, and assist with providing on-going education and support services to adult caregivers.
• Attend weekly meetings with supervisor to consult on cases, to review case plan and direction and to evaluate client participation and progress.
• Maintain effective communication with community agencies or individuals involved in service provision.
• Attend and prepare for required court hearings (if applicable).
• Explore potential community resources and refer Case Managers and families for support, as needed.
• Ability to work flexible hours and work independently within the field.

QUALIFICATIONS

• Bachelor's degree in Social Services or related field of study from an accredited college required.
• Master's degree in Social Services or related field of study from an accredited college, preferred.
• At least two (2) years of experience in child welfare / case management, strongly preferred.
• Prior experience working with refugee and / or immigrant populations preferred.
• Bi-lingual English and Spanish required
• Knowledge of and adherence to federal, state, program, and agency regulations.
• Mature and stable judgment as well as sensitivity to various cultures and the unique history of refugees.
• Must maintain a broad knowledge of basic principles, concepts, and methodology of social work as acquired through a bachelor's level degree or professional experience.
• Excellent verbal and written communication skills.
• Ability to work under stress or in a fast-paced environment.
• Ability to work independently and exercise a high level of confidentiality.
• Computer and typing skills sufficient to perform essential job functions.
• Pass a criminal history screen, including state and local child protection agency registries.

Special Position Requirements

• Fluency in Spanish required
• Valid driver's license required
• Must be able to pass an FBI background check, as well as a CA / N check for every state in which they have resided in the last five years.

Lutheran Immigration and Refugee Service (LIRS) is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity, or expression, or any other characteristic protected by federal, state, or local laws.

We offer a competitive salary and comprehensive benefits package in an innovative and rewarding work environment. Benefits include medical, dental, and vision coverage effective on your first day of employment, 403(b) with company contribution and match, 20 days of vacation per year, tuition reimbursement, professional development and much more.

Salaries are based on the latest market data and reflect the education, skills and requirements for the role. Differentials may exist based on the region and language abilities.