Case Manager III
The Case Manager III performs highly complex (senior level) case management work. Oversees case management activities for all persons at the RGSC Outpatient Clinic. Work involves developing and maintaining long-term contact with patients and families and service providers for medical, social, education plan of care. Develops a plan of care and relative service needs. Accountable for developing, facilitating services, and partnering with community resources to address the needs of the patients. Coordinates medical referrals, interpreter services, DARS, RGVIHCC/ Hidalgo County and Willacy County, Social Security Administration and other services through intra-agency or interagency service coordination and referral incidents. Responsible for ensuring that all patients are evaluated, assessed and referred for assistance through local community, county, state, and federal programs. Prepares and submits monthly, quarterly, and annual reports or performance improvement plans for quality assurance and utilization review processes for case management to ensure quality services.
The Case Manager III functions independently and seeks guidance from leadership as needed. The Case Manager III makes decisions regarding the patient's case with input from the patient, family members if appropriate, and community resources. Supervises the work of others as necessary. Works under limited supervision, with considerable latitude for the use of initiative and independent judgment.
Performs other duties as assigned. Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location.

Essential Job Functions:
Attends work on a regular basis and may be required to work a specific shift schedule or, at times, even a rotating schedule, extended shift and/or overtime in accordance with agency leave policy and performs other duties as assigned.
Will perform Case Management Services and communicate effectively with Rio Grande State Center Outpatient Clinic patients and their families on a timely basis. Maintains confidentiality and ensures appropriate information is documented in the EMR using the Social Work template. Maintain a service log of all monthly referrals. Performs case management services and assignments for patients with special needs. Assists with monitoring the overall program and providing program evaluation. (15%)
Provides options for medical care services such as SSI Disability benefits, medical referrals, insurances, prior authorization, interpreter services, DARS, TDHSH Medicaid/ Snap/TANF, Child and Adult Protective Services, RGVIHCC/ Hidalgo and Willacy, Epilepsy Foundation, UTMB Dysplasia Clinic, Family Crisis Center, Mujeres Unidas, Salud y Vida, Housing Authority, and Breast Cervical Cancer Services, and other entities according to the patient’s individual needs. (15%)
Documents progression of case into the patient’s medical record. Prepares and submits monthly, quarterly and annual performance improvement plans and reports to Quality Management and associated departments. Works closely with other HHSC facilities to ensure continuity of care when patients are transferred between agencies. Works with physicians to ensure referrals are accurate and reflective of treatment orders. (15%)
Interacts with patients and or families, co-workers and stakeholders, in a friendly and professional manner while providing current and correct information to using appropriate resources. Provides timely customer service by demonstrating courtesy, tact, respect, a desire to help, initiate and sense of urgency in all contacts with patients and their families. (15%)
Functions as a team member in the daily operations of the Case Management Department and or in collaboration other departments. Promotes good public relations with the patient care units, hospital departments, and the community. (15%)
Works closely with other HHSC facilities to ensure continuity of care when patients are transferred between agencies. (10%)
Will oversee the referral of services for patients and prepares the quarterly indicator report on findings. Manages Clinic outpatient referrals and ensures patient is contacted within 72 hours to discuss referrals. An appointment with the specialist will be made and will receive reports from the specialist within 14 business days from appointment date. (5%)
Accountable to The Joint Commission (TJC) and Centers for Medicare and Medicaid Services (CMS) standards for accreditation and the required documentation authored by the case manager must meet TJC and CMS standards. Completes such documentation within 72 hours in order to maintain compliance with TJC and CMS standards. (5%)
Performs other duties as assigned. Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location. (5%)

Job Summary