Case Manager | Registered Nurse

Houston Methodist seeks a Case Manager (Registered Nurse) to provide comprehensive care coordination and discharge planning for a targeted patient population on designated units and service lines. This position works collaboratively with physicians and the interprofessional health care team to facilitate compassionate, efficient, quality care and achieve desired treatment outcomes.

The Case Manager holds joint accountability with the social worker for discharge planning and continuity of care. Key responsibilities include assessing medical necessity of admissions and continued stays, communicating clinical information to payors to ensure appropriate reimbursement, and managing complex patient transitions across care settings.

Responsibilities

• Conduct timely and thorough patient assessments and participate in daily Care Coordination Rounds to identify and communicate barriers to efficient patient throughput
• Facilitate discharge planning activities for assigned patients, collaborating with social workers, interprofessional team members, patients, and families on complex discharges
• Initiate and facilitate referrals for home health care, hospice, and durable medical equipment; consult with the Social Worker Case Manager to assess psychosocial needs and ensure appropriate discharge disposition
• Perform medical necessity reviews of admissions, continued stay, and resource use using nationally recognized screening guidelines
• Manage assigned patients in Observation Status daily, informing physicians of timely disposition options to maximize patient benefits and hospital reimbursement
• Apply approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay
• Participate in denial mitigation activities to ensure appropriate reimbursement for services rendered
• Modify care based on continuous evaluation of patient condition, demonstrating clinical problem-solving and evidence-based decision-making
• Document accurate assessments and interventions efficiently and effectively
• Communicate actively and positively with all health care team members, patients, families, and payors; listen and respond to the ideas of others
• Contribute to department and hospital targets for quality, patient satisfaction, safety measures, and length of stay
• Identify areas for improvement based on evidence-based practice literature and participate in performance improvement projects

Required Qualifications

• Active Registered Nurse (RN) license from the Texas Board of Nursing; PSV Compact Licensure accepted with requirement to obtain permanent Texas license within 60 days if establishing Texas residency
• Three years of hospital nursing clinical experience
• Knowledge of Medicare, Medicaid, and Managed Care requirements
• Progressive knowledge of community resources, health care financial and payor requirements, and eligibility for state, local, and federal programs
• Progressive knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement
• Understanding of pre-acute and post-acute venues of care and post-acute community resources
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families
• Proficiency in speaking, reading, and writing English necessary to perform essential job functions, especially regarding patient or employee safety
• Ability to effectively communicate with patients, physicians, family members, and coworkers in a manner consistent with customer service focus
• Proficiency with Microsoft Office Suite (Excel, Outlook, PowerPoint, Word)
• Strong assessment, organizational, and problem-solving skills

Preferred Qualifications

• Bachelor's degree
• Case management experience

Education

• Graduate of an education program approved by the credentialing body for the required credential(s)
• Bachelor's degree preferred

Schedule and Employment

• Day shift (United States of America)
• Exempt FLSA status
• On-call availability required; note that employees may be required to be on-call during emergencies (disaster, severe weather events, etc.) regardless of selection
• Business professional work attire required
• May require travel within the Houston Metropolitan area