Manager, Case Management - The Texas Medical Center

Job Description Summary

The Manager of Case Management is responsible and accountable to assist the Director of Case Management in the implementation of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, Utilization Management, Case Management and Discharge Planning.

The Manager is responsible for coordinating the use systems and processes for care/utilization management at the hospital level. In addition, the Manager is responsible for to assist the Director in managing the departments activities related to discharge planning and clinical quality improvement. The Manager coordinates day to day departmental operations and the use of hospital resources appropriately and effectively. The Manager participates in the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement.

Minimum Qualifications

Education: Bachelors of Science in Nursing OR Social Work (BSW). Master's degree preferred*

*Note: effective March 1, 2019, and going forward, these are the minimum qualifications for this role; incumbents hired before March 1, 2019, may have commensurate experience in lieu of BSN.

Licenses/Certifications:

Current and valid license to practice as a Registered Nurse in the state of Texas or

Licensed Master Social Worker (LMSW) required, LCSW preferred.

Case Manager Certification required.

Experience/ Knowledge/ Skills:

Minimum five (5) years experience in utilization management, case management, discharge planning or other cost/quality management program

Three (3) years of experience in hospital-based nursing or social work

Three (3) years of demonstrated leadership experience.

Knowledge of leading practice in clinical care and payor requirements

Self-motivated, proven communication skills, assertive

Background in business planning, and targeted outcomes

Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management

Working knowledge of the concepts associated with Performance Improvement

Demonstrated effective working relationship with physicians.

Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.

Effective oral and written communication skills

Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of we advance health through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.

Principal Accountabilities

Assists in supervising and managing all aspects of the local level program.

Supports growth and development of the case management program consistent with enterprise-wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed.

Responsible for coordinating day to day operations of the program at the unit level.

Assists in identifying and achieving optimal targeted financial outcomes via the inpatient case management process.

Participates in departmental personnel functions (hiring, firing, etc.) in conjunction with the Director of Case Management.

Provides input to annual and interim performance appraisal reviews for the professional and non-professional staff in department.

Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospitalists, community care managers, nurses, community resources, etc.)

Responsible for leading a high-performance team of system thinkers who incorporate leadership principles and vision in performing the functions of case management.

Uses data to drive decisions, plan, and implement performance improvement strategies for case management.

Ensures safe care to patients, staff and visitors; adheres to facility policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

Other duties as assigned.