System Float Pool - Case Manager - PRN 36 hrs/week

Overview

Case Manager-PRN

• 18 shifts in a 6 week period (4 weekend shifts)
• Must work 1 major holiday, 2 minor holidays
• No benefits No PTO
• Must float to all Houston Methodist hospitals
• Mileage reimbursed
• Magnet - ANCC Recognized Certification - Case Management-related OR ACM - Accredited Case Manager (NBCM) REQUIRED

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience.

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Displays cultural humility, diversity, equity and inclusion principles

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

• Collaborates with the physician and all members of the interprofessional healthcare team to facilitate care for designated assignment; monitors the patient's progress, intervening as needed to ensure that the plan of care and services provided are patient-focused, high quality, efficient, and cost-effective.

• Serves as a preceptor and implements staff education specific to patient populations and unit processes; coaches and mentors other staff and students. Serves a resource for department and hospital. Provides education to physicians, nurses, and other healthcare providers on case management topics.

• Conducts self in a manner that is congruent with cultural diversity, equity and inclusion principles. Initiates contributions towards improvement of department scores for employee engagement, i. e. , peer-to-peer accountability.

• Performs review for medical necessity of admission, continued stay and resource use, appropriate level of care and program compliance. Identifies when services no longer meet InterQual/Milliman l criteria, initiates discussion with attending physicians, coordinates with the external case manager to facilitate discharge planning, seeks assistance from the physician advisor, if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage.

• Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay. Reviews level of care denials to identify trends and collaborate with team to recommend opportunities for process improvement.

• Plans for routine/difficult discharge and anticipates/prevents and manages emergent situations.

• Facilitates timely:
  • Assessment and intervention to prevent or reduce readmission
  • completion of treatment plan and discharge plan
  • modification of plan of care as necessary to meet the ongoing needs of the patient
  • assignment of appropriate levels of care
  • completion of all required documentation in designated EMR and applications or programs
  • elimination of discharge barriers

• Documents assessment and interventions efficiently and effectively. Proactively takes action to achieve continuous improvement and expedite care/facilitate discharge.

• Performs post-discharge review by analyzing the inpatient record to ensure that compliance with quality indicators are met. Intervenes and takes appropriate action to foster real-time compliance with CMS guidelines and other performance measures associated with certification programs and other regulatory, national, regional or locally- sponsored quality programs. Provides reports, as needed, to appropriate parties showing:
  • compliance with established governmental and/or institutional rules and regulations
  • analysis of problematic areas, and
  • actions taken to improve compliance

• Conducts chart audits and performs peer-to-peer evaluations for continuous quality improvement.

• Identifies opportunities to improve patient satisfaction with focus on discharge domain and collaborates with unit leadership to implement evidence-based patient engagement strategies.

• Monitors Length of Stay (LOS) for assigned cases on an ongoing basis. Identifies population and/or service-specific trends impacting LOS and addresses/resolves problems impeding treatment progress. Contributes to meeting department and hospital financial targets, with focus on length of stay.

• Manages all patients in Observation Status, informing physicians of timely disposition options to assure maximum benefits for patients and reimbursement for the hospital.

• Secures reimbursement for hospital services by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, state, and fede.