Case Manager II
Location: Sugar Land
Posted on: October 9, 2019
At Houston Methodist,the Case Manager II (CM II) position is a
licensed registered nurse (RN) who comprehensively plans for case
management of a target patient population on a designated unit(s).
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
II 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 I, the CM II helps drive change by
identifying areas where performance improvement is needed (e.g.,
day-to-day workflow, education, process improvements, patient
PRIMARY JOB RESPONSIBILITIES
Job responsibilities labeled EF capture those duties that are
essential functions of the job.
PEOPLE - 10%
1.Collaborates with the physician and all members of the
interprofessional health care team to facilitate care for
designated case load; monitors the patient s progress, intervening
as needed to ensure that the plan of care and services provided are
patient-focused, high quality, efficient, and cost-effective;
a.completion and reporting of diagnostic testing;
b.completion of treatment plan and discharge plan;
c.modification of plan of care, as necessary, to meet the ongoing
needs of the patient;
d.assignment of appropriate levels of care;
e.completion of all required documentation in EPIC and MIDAS
2.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 case management and
social work resources and needs for the department and the
SERVICE - 20%
1.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/
Millman 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 Non-coverage.
2.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
QUALITY/SAFETY - 30 %
1.Documents assessment and interventions efficiently and
2.Plans for routine/difficult discharge and anticipates/prevents
and manages emergent situations. Specific focus given to discharge
plan and elimination of barriers.
3.Performs post-discharge review by analyzing the inpatient record
to ensure that compliance with quality indicators are met.
Intervenes and takes appropriate action to foster real-time
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:
a. compliance with established governmental and/or institutional
rules and regulations
b.analysis of problematic areas, and
c.actions taken to improve compliance
4.Conducts chart audits and performs peer-to-peer evaluations for
continuous quality improvement.
5.Identifies opportunities to improve patient satisfaction with
focus on discharge domain and collaborates with unit leadership to
implement evidence-based patient engagement strategies.
FINANCE - 25%
1.Monitors Length of Stay (LOS) for case load on an ongoing basis.
Identifies population and/or service-specific trends impacting LOS
and addresses/resolves problems impeding treatment progress.
Proactively takes action to achieve continuous improvement and
expedite care/facilitate discharge. Contributes to meeting
departmental financial target on scorecard
2.Manages all patients in Observation Status, daily, informing
physicians of timely disposition options to assure maximum benefits
for patients and reimbursement for the hospital.
3.Secures reimbursement for hospital services by communicating
medical information required by all external review entities,
managed care contracts, insurers, fiscal intermediaries, and state
and federal agencies. Responds to requests for information,
monitors covered days, and initiates review to assure that all days
are covered and reimbursable.
GROWTH/INNOVATION - 15%
1.Provides education to unit-based physicians, nurses, and other
healthcare providers on case management topics.
2.Identifies opportunity for practice changes. Offers innovative
solutions through evidence-based practice/performance improvement
projects and shared governance activities.
3.Identifies and presents areas for innovation, efficiency and
improvement in case management or department operations using
evidence-based practice literature.
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.
oBachelor of Science degree in Nursing (BSN)
oMaster s degree preferred
oFive (5) years hospital clinical nursing experience which includes
(2) years in case management
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED
oTexas RN license or temporary TX RN license, should obtain
permanent license within 90 days. Compact license acceptable
according to current Board of Nursing requirements.
oAmerican Nursing Credentialing Center (ANCC)-recognized
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
oDemonstrates the skills and competencies necessary to safely
perform the assigned job, determined through on-going skills,
competency assessments, and performance evaluations
oSufficient 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
oAbility 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
oKnowledge of Medicare, Medicaid and Managed Care requirements
oComprehensive knowledge of community resources, health care
financial and payor requirements/issues, and eligibility for state,
local and federal programs
oComprehensive knowledge of discharge planning, utilization
management, case management, performance improvement and managed
oUnderstanding of pre-acute and post-acute venues of care and
post-acute community resources
oAbility to work independently
oStrong assessment, organizational and problem-solving skill as
evidenced by capacity to prioritize multiple tasks and role
oDemonstrates critical thinking and makes decisions using
evidence-based analytical approach in interactions with physicians,
payors, and patients and their families
oWell versed in computer skills of the entire Microsoft Office
Suite (Access, Excel, Outlook, PowerPoint and Word)
oMaintains level of professional contributions as defined in Career
Equal Employment Opportunity
Houston Methodist is an Equal Opportunity Employer.
Equal employment opportunity is a sound and just concept to which
Houston Methodist is firmly bound. Houston Methodist will not
engage in discrimination against or harassment of any person
employed or seeking employment with Houston Methodist on the basis
of race, color, religion, sex,
Keywords: Methodist, Sugar Land , Case Manager II, Executive , Sugar Land, Texas
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