Job Summary  

Our case managers are essential to us at our facilities as they provide support to our physicians, primary medical homes, and interdisciplinary teams. Join a team that is dedicated to providing quality care to our patients. Take on the responsibility of utilization management, care facilitation, discharges, and planning functions to identify areas for improvement. Join a team that is continuously managing effective care plans to meet patient’s needs.  

Minimum Qualifications 

Education: 

• Graduate of an accredited school of professional nursing (Bachelor’s degree in Nursing preferred) or an accredited Master of Social Work program. 

Licenses/Certifications: 

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

Experience / Knowledge / Skills: 

• Three (3) years of nursing or social work experience, preferably in an acute hospital setting, or comparable clinical setting (e.g., ambulatory surgery center, infusion/dialysis clinic, FQHC, skilled nursing facility, wound clinic). 
• Preferred experience in utilization management, case management, discharge planning, or other cost/quality management programs. 
• Excellent interpersonal communication and negotiation skills. 
• Demonstrated leadership skills. 
• Strong analytical, data management, and PC skills. 
• Current 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 care venues, community resources, physician office routines, and transitional procedures. 
• Demonstrated understanding of motivational interviewing and change management. 
• Strong organizational and time management skills, with the ability to prioritize multiple tasks. 
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, patients, and families. 
• Effective oral and written communication skills. 

Principal Accountabilities 

• Care Coordination: Manage patient care progression across the continuum, maintaining active communication with physicians, nurses, and other multidisciplinary team members to ensure timely and appropriate patient care. 
• Problem Resolution: Address and resolve system problems impeding diagnostic or treatment progress; proactively identify and resolve delays and obstacles to discharge. 
• Interdisciplinary Collaboration: Seek consultation from appropriate disciplines/departments to expedite care and facilitate discharge; use advanced conflict resolution skills to ensure timely issue resolution. 
• Patient Monitoring: Collaborate with the physician and multidisciplinary team to monitor patient progress, intervening as necessary to ensure that care plans are patient-focused, high quality, efficient, and cost-effective. 
• Timely Facilitation: Ensure timely completion and reporting of diagnostic testing, treatment plans, and discharge plans; communicate relevant information to third-party payors and the care team. 
• Documentation: Complete all required documentation in TQ screens and patient records, maintaining accuracy and timeliness. 
• Utilization Management: Conduct utilization management and quality screening for assigned patients, applying clinical appropriateness criteria to monitor admissions and continued stays. 
• Risk Identification: Identify at-risk populations using approved screening tools, monitor length of stay and resource use, and take actions to achieve continuous improvement. 
• External Communication: Communicate with external case managers and facilitate referrals for home health care, hospice, medical equipment, and supplies. 
• Discharge Planning: Manage all aspects of discharge planning for assigned patients, collaborating with the patient/family, physician, and multidisciplinary team to develop individualized continuing care plans. 
• Performance Improvement: Actively participate in clinical performance improvement activities, using data to drive decisions and implement strategies related to case management. 
• Mentorship: Act as a preceptor/mentor to new hires, assisting in the development of orientation schedules and identifying individual learning needs. 
• Safety and Compliance: Ensure safe care for patients, staff, and visitors by adhering to all policies, procedures, and standards; promote professional growth and development by meeting continuing education and skills competency requirements. 

Other Duties as Assigned 

• Demonstrate commitment to community care by creating compassionate and personalized experiences. 
• Model service standards by providing safe, caring, personalized, and efficient experiences to patients and colleagues.