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Case Manager

Houston, TX, United States

Position Overview

The Case Manager is integral to supporting physicians, primary medical homes, and interdisciplinary teams. This role facilitates patient care with the goal of improving clinical outcomes, patient satisfaction, and cost management while ensuring timely communication with payors. Responsibilities include coordinating resource utilization, care facilitation, and discharge planning, and driving performance improvements in areas such as workflow, education, and patient satisfaction. The Case Manager manages a specific patient caseload, planning effectively to meet patient needs, provide family support, and ensure efficient resource utilization across the care continuum.

Minimum Qualifications

Education:

Graduate of an accredited nursing school (required)

Bachelor of Nursing preferred

Graduate of an accredited Master of Social Work program

Licenses/Certifications: Valid Texas RN license or LMSW (LCSW preferred)

Case Management certification within two years of hire

Experience/Skills: Three years of nursing or social work experience, preferably in an acute hospital or similar clinical setting

Experience in utilization management, case management, and discharge planning

Excellent interpersonal, communication, and negotiation skills

Leadership abilities and strong analytical skills

Knowledge of discharge planning, case management, performance improvement, and managed care

Familiarity with pre-acute and post-acute care venues and community resources

Proficiency in motivational interviewing and change management

Organizational and time management skills

Ability to work independently and exercise sound judgment

Effective oral and written communication skills

Principal Responsibilities Facilitate patient care progression and maintain active communication with the care team

Identify and resolve system problems that impede diagnostic or treatment progress

Use conflict resolution skills to ensure timely resolution of issues

Monitor patient progress and intervene to ensure high-quality, efficient, and cost-effective care

Complete and report diagnostic testing, treatment plans, and discharge plans promptly

Document care activities in patient records

Collaborate with medical, nursing, and ancillary staff to remove care delivery barriers

Conduct utilization management and quality screening

Monitor length of stay (LOS) and resource use, taking actions for continuous improvement

Communicate with payors and resolve reimbursement issues

Manage all aspects of discharge planning, including patient and family needs assessment

Facilitate referrals for home health care, hospice, medical equipment, and other services

Participate in clinical performance improvement activities and data collection

Mentor new hires and support professional development within the team

Adhere to all organizational policies and promote individual growth through continuing education

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