Case Manager

POSITION SUMMARY :

Under the direction of the Director of Case Management, coordinates patient's care from admission, through hospitalization, to post-discharge follow-up with emphasis on collaborative relationships with patients and families, clinical nurses, physicians, social workers and other health team members to best meet the patient's physical, emotional, and spiritual needs. Specifically, the Case Manager uses a problem solving process that includes assessment, problem identification, goal definition, plan development, evaluation and revision of the plan to achieve optimum patient outcomes.

KEY RESPONSIBILITIES :

• Consistently supports the Mission, Vision and Values of St. Joseph Medical Center.
• Follows the St. Joseph Medical Center Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
• Promotes a culture of safety for patients and employees through proper identification, proper reporting, documentation and prevention of medical errors in a non-punitive environment.
• Demonstrates leadership skills including recognition and acceptance of accountability and responsibility for duties and functions within the scope of the practice of the RN; collaboration with other team members towards problem resolution; precise and appropriate verbal and written communication; and behaviors consistent with the role of the professional nurse.
• Reviews patient's medical records to collect data pertaining to diagnoses and major procedures performed, evaluates appropriateness of admission, observation and length of stay, and completes required forms.
• Performs concurrent reviews of admissions to determine medical necessity for admission, observation and continued stays. Refers those that do not meet criteria to the Medical Director, Case Management.
• Performs concurrent reviews for the appropriateness of resource consumption and refers any over or under utilization to the Medical Director, Case Management.
• Reviews specific incidents and utilization problems with Physician Advisor such as extended hospital stays, complications with care, and patients waiting for placement.
• Participates in Medical Staff department meetings and review teams, as appropriate, in order to provide input regarding incidents, prolonged hospital stays, delays in treatment, quality issues or discharge disposition problems.
• Communicates with physicians as patient's condition warrants, evaluates the physical status and psychosocial adaptation to hospital environment, monitors variances from the Critical Path / Care Plan and collaborates with other members of the health care team to ensure appropriate interventions are implemented.
• Conducts ongoing utilization review for compliance with approved third-party treatment plan and ensures necessary interventions. Communicates with payor's regarding clinical updates and the need for continued hospitalization.
• Identifies high-risk patient and non-patient situations and facilitates problem-solving process with interdisciplinary team as needed.
• Assesses each patient on admission for discharge planning and educational needs, plans the patient's care and ensures that patient family teaching is complete.
• Supportive of the compliance program set forth by SJMC and demonstrated by :
• Upholds the Code of Ethics and Corporate Compliance.
• Adheres to and helps to enforce all compliance policies relevant to his / her area.
• Assures timely compliance education as requested by the Compliance Officer and / or through corporate initiatives.
• Sets an example to all staff in their daily activities.

POSITION QUALIFICATIONS : Equal Opportunity Employer Minorities / Women / Veterans / Disabled

Houston's oldest hospital is GROWING!

Welcome to St. Joseph Medical Center (SJMC), Houston's first and only downtown hospital delivering world-class care for the last 137 years and looking forward to the next century of exceptional care to Houstonians when they need us most.

Whether it's for a scheduled surgery, the birth of a baby, an unexpected emergency, or an outpatient visit, we have staff available around the clock to provide you access to immediate, quality health care. SJMC has been providing health care services to Greater Houston residents for over 130 years, which should give you great comfort in knowing that we have a great tradition of caring for our community. We strive to meet our patients' expectations and encourage our patients to provide us with feedback on how we can help them have the best experience possible while they're in our care.

Over the last years we have expanded our services to include the Advanced Wound Care Center, Comprehensive Cardiac and Vascular Services, the Women's Center, the St. Joseph Maternal Fetal Medicine Center, and a Weight Loss Surgery Program, just to name a few. As you work with our physicians, nurses, case managers, educators, and other staff, you will be guided through your health care journey, from diagnosis to treatment, with compassion every step of the way.

Diversity, equity, inclusion, and belonging are at the foundation of the care St Joseph Medical Center provides to our community we are privileged to support in all of our employment practices. We do not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or expression or any other non-job-related characteristic.