Case Manager
Houston
Job Description Job Description 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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