Case Manager-Registered Nurse (RN)

At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN) responsible for comprehensively planning for case management, which includes care transitions and discharge planning of a targeted patient population on a designated unit(s) and/or service lines. This position works with the physicians and interprofessional health care team to facilitate and maintain compassionate, efficient, quality care and achievement of desired treatment outcomes. The CM position holds joint accountability with the social worker 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. FLSA STATUS Exempt QUALIFICATIONS EDUCATION Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section. Bachelor's degree preferred EXPERIENCE Three years hospital nursing clinical experience Case management experience preferred LICENSES AND CERTIFICATIONS Required RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure - Must obtain permanent Texas license within 60 days (if establishing Texas residency) SKILLS AND ABILITIES Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations Sufficient 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 Ability 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 principles Knowledge of Medicare, Medicaid and Managed Care requirements Progressive knowledge of community resources, health care financial and payor requirements/issues, and eligibility for state, local and federal programs Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement Understanding of pre-acute and post-acute venues of care and post-acute community resources Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families Well versed in computer skills of the entire Microsoft Office Suite (Excel, Outlook, PowerPoint and Word) Strong assessment, organizational and problem-solving skill ESSENTIAL FUNCTIONS PEOPLE ESSENTIAL FUNCTIONS Communicates in an active, positive and effective manner to all health care team members and reports pertinent patient care and family data in a comprehensive and unbiased manner; listens and responds to the ideas of others. Collaborates with staff from the interprofessional health care team concerning safety data to improve outcomes and the safe transition of care. Uses a structured format for regular communication with patients and families. Contributes towards i