- Facilitates pre-certification and payor authorization processes.
- Facilitates collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement.
- Employs process improvement methodologies in evaluating outcomes of care.
- Supports and coaches clinical documentation efforts and serves as a clinical resource for coders ensuring that documentation accurately reflects severity of illness and intensity of service.
- Coordinates communication with physicians.
- Coordinates and facilitates patient care progression throughout the continuum of care.
- Completes Utilization Management and Quality Screening for assigned patients.
- Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, then documents findings based on Department standards.
- Identifies at-risk populations 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 (CMMD) in compliance with Department procedures and follows up as indicated.
- Communicates with business office and payors 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.
- 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.
- Actively participates in clinical performance improvement activities.
- Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, avoidable 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.
- Documents key clinical path variances and outcomes that relate to areas of direct responsibility (e.g., discharge planning).
- Ensures safe care to patients adhering to policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
- Abide by HMH Legal Compliance Code of Conduct.
- Maintains patient confidentiality and appropriate handling of PHI.
- Maintains a safe work environment and reports safety concerns appropriately.
- Performs all other related duties as assigned.
-
PRN RN Case Manager- Saturday/Sunday
16 hours ago
Huntsville Memorial Hospital Huntsville, TX, United StatesUnder general supervision of the Director of Case Management, RN Case Manager provides support to the physician and interdisciplinary team in facilitating patient care, with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction while mana ...
-
Cook- Saturdays and Sundays- Conroe
1 week ago
Voyages Conroe, United StatesCook (not FT) PRN · Saturdaysand Sundays · One Weekend Shift is : 6am to 2:30 · Next Weekend Shift is : 10am to 6:30pm · Voyages Behavioral Health of Conroe · Responsible for proper preparation of patient and cafeteria food service as required by local, state, and federal sta ...
-
Cook- Saturdays and Sundays-Voyages Conroe
3 days ago
PAM Health Conroe, United StatesJob Description · Job DescriptionCook (not FT) PRN · Saturdays and Sundays · One Weekend Shift is : 6am to 2:30 · Next Weekend Shift is : 10am to 6:30pm · Voyages Behavioral Health of Conroe · Responsible for proper preparation of patient and cafeteria food service as required by ...
-
Automation Technician
1 week ago
West Pharmaceutical Services Walker, United StatesRequisition ID: Date: May 6, 2024- Location: Walker, Michigan, US- Department: Maintenance- Description: · - This shift is 5:45 PM - 6:00 AM Wednesday, Thursday, Friday and every other Saturday. · At West, we're a dedicated team that is connected by a purpose to improve patient l ...
-
Plumbing Dispatcher
2 days ago
JD Precision Plumbing Services Conroe, United StatesAre you a customer service rockstar who loves solving problems and keeping things organized? Do you have an affinity for all things plumbing-related and thrive in a fast-paced, customer service-oriented environment? If so, our **part-time Plumbing Dispatcher** position is the per ...
-
Server
17 hours ago
Carriage Inn Conroe Conroe, United States**Cardinal Bay** is a mission-driven, not-for-profit senior living health care organization. We encourage our staff and residents to REACH for the stars Our values focus on: · - Respect · - Excellence · - Appreciation · - Connection · - Honor · Our goal is to help residents to gr ...
-
staff pharmacist-per diem
1 week ago
Comprehensive Pharmacy Services Huntsville, TX, United StatesStaff Pharmacist -Per Diem · Huntsville Memorial Hospital · Huntsville, TX · As a per diem, nonexempt Staff Pharmacist with CPS Solutions, LLC you will fill orders with accuracy; check technician-prepared products before release; maintain security of pharmacy and controlled subst ...
-
Registered Nurse
1 week ago
Voyages Behavioral Health Conroe, United States**Voyages Behavioral Health of Conroe** · **Registered Nurse-Full-Time Full Benefits Package** · **Night Shift 7:00 pm-7:30 am** · **Rotating Schedule with every other Friday, Saturday, and Sunday off.** · Under the direction of the Chief Nursing Officer or House Supervisor, the ...
-
Mental Health Technician-ft Day Shift
17 hours ago
Voyages Behavioral Health Conroe, United States**Voyages Behavioral Health Hospital of Conroe, TX** · **Full Time - Day Shift 7am-7:30pm rotating shift with every other Friday, Saturday, and Sunday Off.** · **Mental Health Tech** · **Full Benefit Package** · **RESPONSIBILITIES (not all inclusive)** · - Observes, reports, and ...
-
Mental Health Technician-ft Night Shift
17 hours ago
Voyages Behavioral Health Conroe, United States**Voyages Behavioral Health Hospital of Conroe, TX** · **Full Time - Day Shift 7pm-7:30am rotating shift with every other Friday, Saturday, and Sunday Off.** · **Mental Health Tech** · **Full Benefit Package** · **RESPONSIBILITIES (not all inclusive)** · - Observes, reports, and ...
-
Bilingual Program Assistant
1 week ago
Montgomery County Youth Services Conroe, United States**Summary of Position** · The Bilingual Program Assistant performs administrative duties for Youth and Family Services staff. This position is primarily responsible for answering phones, data-entry, communication and processing the daily flow of information to the appropriate sta ...
-
Preschool Soccer Coach
1 week ago
Soccer Shots - The Woodlands/Spring Conroe, United States**Benefits**: · - Bonus based on performance · - Employee discounts · - Flexible schedule · - Free uniforms · - Opportunity for advancement · - Training & development · **Position Overview** · We're hiring part-time soccer coaches with opportunities for future full-time employmen ...
-
Facility General Manager for Baseball/softball
17 hours ago
Infinite Hitting - Woodlands Conroe, United StatesPosition Summary: · A General Manager is responsible for client acquisition and client retention. You will be in charge of sales of clients for different membership packages along with making sure those clients are staying. The objective is to get baseball and softball players ga ...
-
Communications Director
1 week ago
First Methodist Conroe Conroe, United States**Responsibilities**:In this role the responsibilities include, but are not limited to the following: · - A daily walk with God and Christian living. · - Finding community among us as you support the DNA that God has called First Methodist Conroe as you: · - Manage church-wide co ...
-
General Production Laborer
2 days ago
Ameritex Conroe, United States**Hiring Immediately Direct Hire** · **Payrate: $14 (Weekly Pay)** · **Schedule: Monday - Friday and select Saturdays 5am - 5:30pm** · **Full benefits at 60 days** · This role is a main contributor to the daily manufacturing requirements and output for the facility. Provides gene ...
-
Loan Specialist
4 days ago
Regional Finance Corp. of Texas Conroe, United StatesAre you ready to take your career to the next level? Regional strives to positively impact the financial lives of our customers. · For over 35 years, our Team Members have been passionate about supporting customers through their financial challenges in life. They take pleasure in ...
-
Make Ready Technician
4 days ago
Montgomery County Hospital District Conroe, United States**TITLE**:Make Ready Technician · **DEPARTMENT**:Materials Management · **REPORTS TO**:Materials Management Manager · **FLSA STATUS**: Non-Exempt · **SUMMARY** · The ambulance make-ready tech is responsible for assuring that designated ambulances are ready for service. · **ESSENT ...
-
Deconstruction and Procurement Manager
17 hours ago
Montgomery County Habitat for Humanity, Inc. Conroe, United StatesDeconstruction & Donation Manager · - Habitat for Humanity Montgomery County TX revitalizes neighborhoods, builds affordable and sustainable homes, and empowers families through successful homeownership right here in Montgomery County Texas. We believe that everyone deserves the ...
-
Production Associate
1 week ago
Stainless Structurals Conroe, United States_**Production Associate**_ · **Job Overview**: · As a Production Associate, you will be trained on how to help manufacture Stainless Structurals product to the highest standard. If you have a strong work ethic, are reliable and flexible then a career at Stainless Structurals is r ...
-
109 Retail
1 week ago
Specs Family Partners Ltd Conroe, United StatesSummary · The individuals who perform this job provide extraordinary shopping experiences to our guests and help them find stocked and in-date product. · Essential · **Responsibilities**: · Including, but not limited to, the following: · 1. Know and actively demonstrate, daily, o ...
PRN RN Case Manager- Saturday/Sunday - Huntsville, United States - Huntsville Memorial Hospital
Description
Job Description
Job DescriptionUnder general supervision of the Director of Case Management, RN Case Manager provides support to the physician and interdisciplinary team in facilitating 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 utilization management, care facilitation and discharge planning functions. The RN Case Manager is accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include:
ESSENTIAL JOB FUNCTIONS
Every effort has been made to make this job description as complete as possible. However, it in no way states or implies that these are the only duties the incumbent will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or is a logical assignment to the position.
LATITUDE, CONTACTS/INTERACTIONS
All positions of Huntsville Memorial Hospital are part of an interdisciplinary team, and as such, participate in the care and service delivery process through effective interaction with other team members. Primarily interacts with hospital staff, medical staff, patients, and visitors.
Requirements
Education: Graduate of a school of professional nursing.
Experience: Two years of clinical nursing experience preferred as well as two years of hospital case management experience.
Licensure/Certification: Current licensure as a Registered Nurse in the state of Texas. Certification with the Fellowship of American Academy of Case Managers (FAACM) preferred.
Required Skills: Must have strong analytical, data management, organizational and time management skills. Performs duties in a manner to promote quality patient care and customer service / satisfaction, while promoting safety, cost efficiency, and a commitment to the CQI process.
PHYSICAL DEMANDS AND WORKING CONDITIONS
Frequent: sitting, standing, walking, & reaching.
Occasional: lifting, carrying, bending, & squatting,
Visual and hearing acuity required. Work is inside, with good ventilation and comfortable temperature.
Possible exposure to: toxic/caustic chemicals or detergents, communicable diseases, blood borne pathogens.