Manager, Process Management – Banker Efficiency & Effectiveness
Capital One
Case Manager, RN
Houston Methodist
full-time
Posted on:
Location Type: Hybrid
Location: Houston • Texas • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Communicates in an active, positive and effective manner to all health care team members
- Collaborates with staff from the interprofessional health care team to improve outcomes
- Uses a structured format for regular communication with patients and families
- Assesses all patients timely and thoroughly
- Participates in daily Care Coordination Rounds (CCR)
- Supports patients and families in preventing/resolving clinical or ethical issues
- Facilitates discharge planning activities for assigned patients
- Maintains ownership of the discharge planning process on assigned units
- Initiates and facilitates referrals for home health care, hospice, and durable medical equipment
- Consults with Social Worker Case Manager to assess psychosocial needs associated with transition to alternative levels of care
- Modifies care based on continuous evaluation of the patient's condition
- Documents accurate assessment and interventions efficiently and effectively
- Plans for routine discharge and elevates emergent situations
- Performs review for medical necessity of admission, continued stay and resource use
- Participates in denial mitigation activities to ensure appropriate reimbursement for services rendered
- Contributes to meeting department and hospital financial target
- Initiates evidence-based practice/performance improvement projects
- Seeks opportunities to identify self-development needs and takes appropriate action
Requirements
- Graduate of education program approved by the credentialing body for the required credential(s)
- Bachelor's degree preferred
- Three years hospital nursing clinical experience
- Case management experience preferred
- RN - Registered Nurse - Texas State Licensure -- Compact Licensure - Must obtain permanent Texas license within 60 days (if establishing Texas residency)
- Demonstrates the skills and competencies necessary to safely perform the assigned job
- Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job
- 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
- Well versed in computer skills of the entire Microsoft Office Suite
Benefits
- Health insurance
- 401(k) matching
- Paid time off
- Flexible working arrangements
- Professional development opportunities
- On-call duty
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
nursingcase managementdischarge planningutilization managementperformance improvementclinical assessmentdocumentationevidence-based practicemedical necessity reviewresource management
Soft skills
communicationcollaborationproblem-solvingindependent judgmentpatient advocacyorganizational skillsinterpersonal skillsactive listeningfacilitationself-development
Certifications
RN - Registered NurseTexas State LicensureCompact Licensure
