Job Summary and QualificationsThe manager of case management reports directly to the Director of Case Management and provides oversight to the Case management team (as directed by the DCM). She/he is co-responsible for coordinating, monitoring, executing and evaluating Case Management Department activities. The individual in this position is accountable for assisting hospital utilization performance improvement in order to promote effective utilization of hospital resources, ensure processes support appropriate reimbursement for services rendered, support efficient patient throughput, and ensure compliance with all state and federal regulations related to case management services.
This position integrates national standards for case management scope of services including:
- Utilization Management supporting medical necessity and denial prevention
- Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
- Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
- Compliance with state and federal regulatory requirements, TJC accreditation standards and HCA policy
- Education provided to physicians, patients, families and caregivers
- Manage department operations to assure effective throughput and reimbursement for services provided
- Ensure medical necessity review processes are completed accurately and in compliance with CMS regulations and HCA policy
- Ensure timely and effective patient transition and planning to support efficient patient throughput
- Implement and monitor processes to prevent payer disputes
- Develop and provide physician education and feedback on hospital utilization
- Ensure compliance with state and federal regulations and TJC accreditation standards and other duties as assigned
What qualifications you will need:- (RN) Registered Nurse license required
- Bachelors Degree required, or Masters Degree preferred
- One year acute hospital case management leadership experience preferred. Accredited Case Manager (ACM) preferred. McKesson InterQualae experience preferred. Two years acute hospital case management experience preferred.
HCA Houston Healthcare Northwest is a
415+ bed acute care hospital that has been serving the north Houston communities for more than 40 years, providing a wide range of medical services including cardiology, maternity care,
Level III NICU, pediatrics, bariatrics and neurology. We comprehensively serve our community by employing expert physicians, specialists, nurses and support staff who work together as a unified team to offer a range of diagnostic treatment and support services. From our 24-hour emergency department with
Level II Trauma capabilities, to womens services, to cardiology, we are dedicated to improving the health of our community by delivering exceptional, personalized healthcare. We are members of HCA Houston Healthcare, the most comprehensive family of hospitals in the region and part of the leading provider of healthcare in the country, HCA Healthcare. Together we are stronger, smarter and more accessible in providing the patient-centered care you need close to home.
