Director, Case Management – Houston, TX - $125,000 - $156,600

Director, Case Management – Houston, TX
$125,000 - $156,600


The Director of Case Management is responsible and accountable for 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 Director is responsible for developing systems and processes for care/utilization management and discharge planning at the hospital level.  In addition, the Director may be responsible for managing the department’s activities related to discharge planning and clinical quality improvement.  The Director evaluates and ensures that hospital resources are used appropriately and effectively.  The Director oversees the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement.  The Director promotes interdisciplinary collaboration, fosters teamwork and champions service excellence.

Minimum Qualifications

Education: Bachelors of Nursing (BSN) or Masters Social Work (MSW); Masters degree preferred

Licenses/Certifications:

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

·         Current and valid Texas license as a Master’s Social Worker (LMSW), required

·         LCSW preferred and Certified Case Manager (CCM), Accredited Case Manager (ACM) or

·         Fellowship of the American Academy of Case Management (FAACM), required

Principal Accountabilities

·         Plans, directs and supervises all aspects of the local level program.

·         Facilitates 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 approving and managing the day to day local level operational budget.

·         Assures that revenue, expenses, contribution margin and FTE’s meet or exceed budget.

·         Prepares and submits budget and related reports.

·         Forecasts and accurately projects expenses.

·         Takes corrective action to address negative variances.

·         Identifies and proposes capital budget items appropriately.

·         Identifies and achieves optimal targeted financial outcomes via the inpatient case management process.

·         Responsible for departmental personnel functions (hiring, firing, etc.) in conjunction with the Executive Director of Medical Management.

·         Writes and conducts 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.

·         Oversees the education of physicians, managers, staff, patients and families related to the case management process at the local level.

·         Participates in this evolutionary process by constantly identify future needs of current customers and/or identifying potential new customers.

·         Ensures safe care to patients, staff and visitors; adheres to all Our Client’s 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.

·         Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Our Client’s’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

·         Other duties as assigned..

Social Worker for The Texas Medical Center - Houston, TX - $66,788 - $78,582

Social Worker for The Texas Medical Center

Houston, TX

$66,788 - $78,582

Job Description

The Licensed Master Social Worker systematically intervenes to provide clinical social work and complex discharge planning to patients and their families who have complex psychosocial needs, require assistance with eligibility determination for social programs and funding sources and qualify for community assistance from a variety of special funds and agencies. Under the supervision of a licensed clinical social worker, offer crisis intervention and/or mental health assessment to patients and families with psychosocial needs and coordinates and facilitates the development of a multidisciplinary discharge plan of care for high-risk patient populations. This role will participate in an interdisciplinary team (including Physicians, Case Managers, Staff Nurses and other members of the care team) to provide services for individuals from at-risk population and ensure that psychosocial issues are attended to and treated as required across the continuum of care.

Typically reports to the Manager or Director, Case Management.

Minimum Qualifications

·        Education: Graduate of an accredited Master of Social Work program (MSW)

·        Licenses/Certifications: Current license as a Master Social Worker (LMSW) in the state of Texas required; ACM certification from American Case Management Association (ACMA) preferred

Experience / Knowledge / Skills:

·        Field placement or internship in health services/health care provider experience.

·        Acute inpatient hospital social work experience preferred.

·        Effective oral and written communication skills.

·        Working knowledge of DSM V and ICD-10 manuals.

·        Demonstrates knowledge and skill in social work assessment and treatment of patients for mental health status and substance abuse screening.

·        Excellent therapeutic communication and negotiation skills in interactions with patients, families, physicians and health care team colleagues.

·        Strong analytical skills.

·        Working knowledge and/or experience in utilization management, managed care, and payer issues.

·        Exposure and/or experience in pre-acute and post-acute care, as well as community resources.

·        Ability to work independently, as well as to develop collaborative relations with physicians, families, patients, interdisciplinary team and other community agencies.

·        Effective oral and written communication skills.

Principal Accountabilities

·        Assesses patient’s and family’s psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness and ability to cope.

·        As part of a multidisciplinary team, develop and carry out a treatment plan by the use of a clinical social work diagnoses, assessments, and treatment interventions.

·        Intervenes with patients and families regarding emotional, social, and financial consequences of illness and/or disability; accesses and mobilizes family/community resources to meet identified needs. Under supervision this may include short term individual, marital and family therapies as well as crisis intervention.

·        Provides intervention in cases involving child abuse/neglect, domestic violence, guardianship (temporary/permanent), institutional abuse, foster care, adoption, mental health placement, advance directives, adult/elderly abuse, child protection and sexual assault.

·        Serves as a resource person and provides counseling and intervention related to treatment decisions and end-of-life issues.

·        Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system.

·        Participates in discharge planning activities for complex patients in order to ensure a timely discharge and to provide appropriate linkage with post-discharge care providers.

·        Deals with families exhibiting complex family dynamics that impact directly on patient care and discharge.

·        Communicates with clinical care team members regarding the discharge planning status of all patients referred by them.

·        Provides consultation to Case Managers when coordination with significant or intensive community resources is necessary to achieve desired treatment outcomes.

·        Receives referrals for complex patient problem resolution from Case Managers or clinical care team members.

·        Works in collaboration with the clinical and case management team members on transition planning and referrals to post acute care providers. Keeps clinical and case management team members up-to-date on the status of the post-acute provider acceptance and clearance for discharge.

·        Validates discharge criteria for patient and families and notifies clinical and case management team members of newly-identified resources or change in previously-identified resources.

·        Educates patient/family and physician regarding post-acute options and addresses issues of choice.

·        Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann 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.

·        Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

·        Other duties as assigned.

Director, Case Management for Pearland - Houston, TX - $122,803 - $153,504

Director, Case Management for Pearland

Houston, TX

$122,803 - $153,504

Job Description

The Director of Case Management is responsible and accountable for 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 Director is responsible for developing systems and processes for care/utilization management and discharge planning at the hospital level.  In addition, the Director may be responsible for managing the department’s activities related to discharge planning and clinical quality improvement.  The Director evaluates and ensures that hospital resources are used appropriately and effectively.  The Director oversees the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement.  The Director promotes interdisciplinary collaboration, fosters teamwork and champions service excellence.

Minimum Qualifications

·        Education: Bachelors of  Nursing (BSN) or Masters Social Work (MSW); Masters degree preferred

Licenses/Certifications:

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

·        Current and valid Texas license as a Master’s Social Worker (LMSW), required

·        LCSW preferred and  Certified Case Manager (CCM), Accredited Case Manager (ACM) or

·        Fellowship of the American Academy of Case Management (FAACM), 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 preferred

·        5 years supervisory experience

·        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

Principal Accountabilities

·        Plans, directs and supervises all aspects of the local level program.

·        Facilitates 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 approving and managing the day to day local level operational budget.

·        Assures that revenue, expenses, contribution margin and FTE’s meet or exceed budget.

·        Prepares and submits budget and related reports.

·        Forecasts and accurately projects expenses.

·        Takes corrective action to address negative variances.

·        Identifies and proposes capital budget items appropriately.

·        Identifies and achieves optimal targeted financial outcomes via the inpatient case management process.

·        Responsible for departmental personnel functions (hiring, firing, etc.) in conjunction with the Executive Director of Medical Management.

·        Writes and conducts 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.

·        Oversees the education of physicians, managers, staff, patients and families related to the case management process at the local level.

·        Participates in this evolutionary process by constantly identify future needs of current customers and/or identifying potential new customers.

·        Ensures safe care to patients, staff and visitors; adheres to all 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.

·        Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

·        Other duties as assigned.

Director, Care Management -The Texas Medical Center - Houston, TX - $141,128 - $176,404

Director, Care Management -The Texas Medical Center

Houston, TX

$141,128 - $176,404

Job Description

The Director of Care Management is responsible and accountable to work with the Directors of Case Management on 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 Director is responsible for overseeing/suggesting the development of systems and processes for care/utilization management at the local level.  In addition, the Director is responsible for monitoring the progress of hospital department activities related to discharge planning and clinical quality improvement.  The Director works with the local level Directors on matters that impact resource utilization and promotes the effective and appropriate use of hospital resources.  The Director supports the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement.  The Director promotes interdisciplinary collaboration, fosters teamwork and champions service excellence.

Minimum Qualifications

·        Education: Bachelors of Nursing (BSN) or Masters Social Work (MSW). Masters degree preferred

Licenses/Certifications:

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

·        Current and valid Texas license as a Master’s Social Worker (LMSW) required,

·        LCSW preferred and  Certified Case Manager (CCM), Accredited Case Manager (ACM) or

·        Fellowship of the American Academy of Case Management (FAACM) 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 preferred

·        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

Principal Accountabilities

·        Works in collaboration with the local level Directors of Case management to plans and coordinate all aspects of the local level program.

·        Facilitates 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.

·        Identifies and achieves optimal targeted clinical and financial outcomes via the case management process.

·        Assures that revenue, expenses, contribution margin and FTE’s meet or exceed budget.

·        Prepares and submits budget and related reports.

·        Forecasts and accurately projects expenses.

·        Takes corrective action to address negative variances.

·        Identifies and proposes capital budget items appropriately.

·        Participates in the annual and interim performance appraisal reviews of the Directors of Case Management.

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

·        Leads 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.

·        Oversees the education of physicians, managers, staff, patients and families related to the case management process at the system level.

·        Participates in this evolutionary process by constantly identify future needs of current customers and/or identifying potential new customers.

·        Responsible for the ongoing development of the Care Management program to extend beyond the acute inpatient environment.

·        Ensures safe care to patients, staff and visitors; adheres to all 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.

·        Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

·        Other duties as assigned.

Case Manager position for Southwest Hospital - Houston, TX - $92,955 - $109,345

Case Manager position for Southwest Hospital

Houston, TX

$92,955 - $109,345

Job Description

We pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

The purpose of the Case Manager position is to support the physician, primary medical homes, and interdisciplinary teams. Facilitates patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while managing the cost of care and providing timely and accurate information to payors. The role integrates and coordinates resource utilization management, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction). The position is responsible for coordinating a wide range of self management support and provides information to update and maintain relevant disease registry activity. Accountable for a designated patient caseload and plans effectively in order to meet patient needs across the continuum, provide family support, manage the length of stay, and promote efficient utilization of resources.

Minimum Qualifications

·        Education: Graduate of an accredited school of professional nursing required; Bachelors of Nursing preferred, or graduate of an accredited Masters of Social Work program.

Licenses/Certifications:

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

·        Current and valid license as a Master Social Worker (LMSW) in the state of Texas required, LCSW preferred.

·        Certification in Case Management required within two (2) years of hire into the Case Manager position.

Experience / Knowledge / Skills:

·        Three (3) years of nursing or social work experience acute hospital-based preferred, or three (3) years of experience comparable clinical setting (i.e., ambulatory surgery center, infusion/dialysis clinic, Federally Qualified Health Clinic (FQHC), skilled nursing facility, or wound clinic).

·        Experience in utilization management, case management, discharge planning or other cost/quality management program preferred.

·        Excellent interpersonal communication and negotiation skills.

·        Demonstrated leadership skills.

·        Strong analytical, data management and PC skills.

·        Current working knowledge of discharge planning, utilization management, case management, performance improvement, disease or population management and managed care reimbursement.

·        Understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre and post acute care. Demonstrated understanding of motivational interviewing and change management.

·        Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.

·        Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families.

·        Effective oral and written communication skills.

Principal Accountabilities

·        Coordinates/facilitates patient care progression throughout the continuum.

·        Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient care.

·        Addresses/resolves system problems impeding diagnostic or treatment progress. 

·        Proactively identifies and resolves delays and obstacles to discharge.

·        Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.

·        Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues. 

·        Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load. Monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.

·        Facilitates the following on a timely basis: Completes and reports diagnostic testing, Completes treatment plan and discharge plan, Modifies plan of care as necessary, to meet the ongoing needs of the patient, Communicates to third party payors and other relevant information to the care team.

·        Assigns appropriate levels of care.

·        Completes all required documentation in TQ screens and patient records.

·        Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.

·        Completes Utilization Management and Quality Screening for assigned patients.

·        Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Department standards.

·        Identifies at-risk populations using approved screening tool and follows established reporting procedures. Monitors LOS and ancillary resource use on an ongoing basis. 

·        Takes actions to achieve continuous improvement in both areas.

·        Refers cases and issues to Care Management Medical Director in compliance with Department procedures and follows up as indicated.

·        Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients. 

·        Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.

·        Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.

·        Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.

·        Manages all aspects of discharge planning for assigned patients.

·        Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician.

·        Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation.

·        Ensures/maintains plan consensus from patient/family, physician and payor.

·        Refers appropriate cases for social work intervention based on Department criteria.

·        Collaborates/communicates with external case managers.

·        Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment and supplies.

·        Documents relevant discharge planning information in the medical record according to Department standards.

·        Facilitates transfer to other facilities as appropriate.

·        Actively participates in clinical performance improvement activities.

·        Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.

·        Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data.

·        Collects, analyzes and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team. 

·        Uses concurrent variance data to drive practice changes and positively impact outcomes.

·        Collects delay and other data for specific performance and/or outcome indicators as determined by Director of Outcomes Management. Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning).

·        Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.

·        Leads the development, implementation, evaluation and revision of clinical pathways and other Case management tools as a member of the clinical resource/team.

·        Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators (e.g., readmission rates, unplanned return to OR, etc.)

·        Acts as preceptor/mentor to new hires. 

·        Assists in development of orientation schedule and helps identify individual needs for learning.

·        Ensures safe care to patients, staff and visitors; adheres to all 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.

·        Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

·        Other duties as assigned.

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