Guthrie Case Update Jobs in Usa
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BJC Home Care is looking for you! The home health registered nurse provides 1:1 patient care supporting an under-served community. All while attaining work-life balance and setting up your own schedule.
As a registered nurse at BJC Home Care, you'll have the chance to build meaningful relationships with patients while providing them with the care they need in a supportive team environment. Don't miss out on this chance to join our team and make a difference in the lives of those in our community.
Learn more here:
Schedule
8:00 - 4:30 pm
Weekend rotation: generally every 4th
4 to 6 on-call nights per month
Holiday requirements: 2 per year
Location
St. Charles Region
Perks
Cell phone and lap top
Mileage Reimbursement at IRS rate .70/mile
Up to $15,000 bonus for eligible candidates
Relocation available for eligible candidates
*BJC Career Ladder Progression available:
- The BJC RN Career Ladder differentiates BJC as the place for nurses to work in the greater St. Louis area.
- This is a tool to empower nurses to work at the top of their license and own their career progression.
- The BJC RN Career Ladder promotes professional development, leadership, collaboration, education and service excellence and gives staff the opportunity to continue doing what they do best - caring for patients - while having the opportunity to advance to the next step in their career.
- Moves to higher ladder levels will result in a percentage increase of current pay that aligns with the new job description.
*must be willing to provide coverage in all St. Louis regions during on-call
*Position requires registration with the Family Care Safety Registry
#LI-TP1
Overview
BJC Home Care offers patients and their families a complete range of home care services, including skilled nursing services, adult and pediatric hospice and supportive care, rehabilitation therapy, home infusion therapy, infusion treatment rooms, home medical equipment and high-tech respiratory care. Specialty home care programs also are available, including adult and pediatric asthma, cardiac, diabetes, orthopedic and wound care programs.
BJC Home Care provides care to thousands of patients in both Missouri and Illinois. Serving more than 25 counties, it has become the largest home care network in the region and one of the largest in the country.
The Metro St. Louis Intermittent Home Care Department of BJC Home Care Services provides home visits to patients in the metropolitan St. Louis area and several nearby counties, with 24 hour on-call home care nursing supervision. Our JCAHO accredited, multi-disciplinary approach combines leading edge technology with a firm belief in the powerful recuperative advantages of receiving home care.
Preferred Qualifications
Role Purpose
Evaluates the client and furnishes services requiring substantial and specialized skill, appropriate preventive and rehabilitative nursing procedures, and instructions to assist the client in learning appropriate self-care techniques. When assigned as case manager, the staff nurse is responsible for coordinating all aspects of care related to that patient.
Responsibilities
- Assess patient preferences and barriers to involvement in care, including their values, emotional, spiritual, cultural, and population-specific needs.
- Develops, implements, and documents individual plans of care with defined goals in collaboration with other members of the interprofessional team and patient, family or caregiver in accordance with the established guidelines and standards of nursing care. Proactively plans and ensures communication of the plan of care across the continuum of care.
- Promotes respect, equity and empathy in interactions with diverse and vulnerable populations through care delivery (e.g. support for emotional, spiritual, and cultural preferences of patient, family and/or caregivers). Practices collaborative problem solving, service recovery and advocacy for patient family centered continuity of care. Implements care by integrating data from the interprofessional team and critical thinking in a safe and timely manner.
- Evaluates changes in patient's condition, informs and collaborates with family and/or caregivers, and communicates with interprofessional team as changes occur in plan of care, updates plan of care in EMR. Evaluates current nursing care to ensure evidence-based practice and quality patient outcomes.
- BJC has determined this is a safety-sensitive position. The ability to work in a constant state of alertness and in a safe manner is an essential function of this job.
Minimum Requirements
Education
- Nursing Diploma/Associate's
- Nursing
Experience
- Supervisor Experience
- No Experience
Licenses & Certifications
- Valid Driver's License
- RN
Preferred Requirements
Education
- Bachelor's Degree
- Nursing/Home Health
Experience
- 2-5 years
Benefits and Legal Statement
BJC Total Rewards
At BJC we’re committed to providing you and your family with benefits and resources to help you manage your physical, emotional, social and financial well-being.
- Comprehensive medical, dental, vison, life insurance, and legal services available first day of the month after hire date
- Disability insurance* paid for by BJC
- Annual 4% BJC Automatic Retirement Contribution
- 401(k) plan with BJC match
- Tuition Assistance available on first day
- BJC Institute for Learning and Development
- Health Care and Dependent Care Flexible Spending Accounts
- Paid Time Off benefit combines vacation, sick days, holidays and personal time
- Adoption assistance
To learn more, go to our Benefits Summary .
*Not all benefits apply to all jobs
The above information on this description has been designed to indicate the general nature and level of work performed by employees in this position. It is not designed to contain or be interpreted as an exhaustive list of all responsibilities, duties and qualifications required of employees assigned to this job. Equal Opportunity Employer
Location Address:
5901 Harper Dr NEAlbuquerque, NM 87109-3587
Compensation Pay Range:
Minimum Offer $62,400.00Maximum Offer $95,305.60
Summary:
Build your Career. Make a Difference. Presbyterian is hiring an RN Case Manager for the Employee Health Clinic at Northside. The Case Manager independently facilitates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomesHow you grow, learn and thrive matters here.
• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
• Malpractice liability insurance
• Loan forgiveness through the New Mexico Higher Education Department
• EPIC electronic charting system
Type of Opportunity: Full time
FTE: 1.00
Job Exempt: Yes
Work Shift: Days (United States of America)
Responsibilities:
- Identifies cases appropriate for case management. Educates providers and other PHS/PHP departments on case management services. Screens new referrals for case management appropriateness.
- Conducts in-depth assessment which includes, but is not limited to, psychosocial, physical, medical, environmental and financial parameters. Advocates for members in caseload
- Identifies cases appropriate for case management. Educates providers and other PHS/PHP departments on case management services. Screens new referrals for case management appropriateness.
- Conducts in-depth assessment which includes, but is not limited to, psychosocial, physical, medical, environmental and financial parameters. Advocates for members in caseload.
- Formulates, implements, coordinates, monitors, and evaluates strategies for patients and families collaboratively with members, families and health care teams. Develops, documents and implements plans which provide appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs.
- Actively participates in the development of clinical guidelines and pathways and incorporates processes into the role of case managers.
- Educates providers on health management strategies which can reduce need for one-on-one case management services. Educate physicians, nurses, ancillary support staff, patients, and families regarding case management role.
- Refers patients to appropriate inpatient, outpatient, and community resources.
- Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and patient satisfaction. Collect clinical path variance data that indicate potential areas for improvement of case and services provided within the system. Generates reports, which demonstrate efficacy through direct cost-savings and outcome measures.
- Complies with Case management Society of America Standards for Case Management Practice and with CCMC code of Professional Conduct for Case Managers.
- Performs other functions as required.
Qualifications:
*Associates Degree in Nursing
*State of New Mexico or Compact State Nursing License
*BLS certification REQUIRED at at time or hire
*Five years of experience in clinical nursing with a minimum of three to five in case management, utilization management, quality assurance, home care, community health, or occupational health.
*CCM certification within 3 years of hire.
*Employee Health experience preferred.
We're all about well-being, starting with yours.
Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more.
Learn more about our employee benefits.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Compensation Disclaimer
The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.
General Summary of Position
An exciting new role has been added to the team, offering a unique opportunity to make a direct impact on patient outcomes at a critical point in care. The In-Hospital Transition of Care RN Case Manager partners closely with hospital discharge planners to coordinate patient care at discharge, ensuring seamless continuity across care settings and reducing avoidable readmissions through proactive coordination, patient education, and timely follow-up.
This position is based at either Washington Hospital Center or The Psychiatric Institute of Washington (PIW) and offers the opportunity to work across diverse patient populations, with flexibility to provide coverage at both locations.
In this highly collaborative and autonomous role, the RN Case Manager manages a complex caseload and takes ownership of case management program(s), driving high-quality, cost-effective outcomes while enhancing the patient experience. The role includes coordinating and managing care for members/enrollees, completing pre-authorization reviews to ensure medical necessity and timely access to services, and conducting pharmacy reviews aligned with the population served. Working alongside an interdisciplinary team, you will play a key role in discharge planning, connecting patients to the right resources, and ensuring smooth transitions across the continuum of care.
This is an excellent opportunity for a nurse who thrives in a fast-paced environment, values critical thinking and autonomy, and is passionate about improving care transitions and patient outcomes. We are committed to fostering a supportive, inclusive environment where associates from diverse backgrounds can grow, advance, and make a meaningful difference.
Primary Duties and Responsibilities
- Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
- Actively develops and manages complex case management cases and develops individualized plans of care according to NCQA standards/ guidelines and the District of Columbia Contract.
- Acts as a liaison to MedStar Family Choice contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care.
- Acts as an advocate while assisting members/enrollees to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy.
- Assists hospital case management staff with discharge planning if applicable. Makes recommendation to alternate tier of Case Management programs or level of care as acuity necessitate.
- Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups District/ community agencies meetings etc. as assigned. Provides input completes assignments and shares new findings with other staff. Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
- Provides face to face case management in the community as the member/enrollee's health necessitate.
- Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
- Demonstrates skill and flexibility in providing coverage for other staff.
- For assigned Case Management program(s) develops strategies assessment(s) and evaluation/goal tools according to NCQA standards/ guidelines and District of Columbia Contract for the population served. Utilizes standards/ guidelines to manage and document interactions for the program (s). Responsible for verifying that assigned program utilizes up-to-date standards in the medical and behavioral health community for the population served. Keeps informed about disease processes treatment modalities and resources.
- Identifies and reports potential coordination of benefits subrogation third party liability worker's compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel.
- Identifies inpatients requiring additional services and initiates care with appropriate practitioners.
- Maintains current knowledge of MFC benefits and enrollment issues in order to accurately coordinate services.
- Maintains timely and accurate documentation in the clinical software system per Clinical Operation department's policy.
- Monitors utilization of all services for fraud waste and abuse.
- Performs telephonic ACD line coverage for Clinical Operations' needs.
- Enters authorization as appropriate to the program and sends the reviews to Medical Director as appropriate. Coordinates review decisions and notifications per policy NCQA standards/ guidelines and District of Columbia Contract for timely decision making.
- Participates in meetings and on committees and represents the department and hospital in community outreach efforts.
- Participates in multi-disciplinary quality and service improvement teams.
Minimal Qualifications
Education
- Graduate of an accredited School of Nursing required and
- Bachelor's degree preferred
Experience
- 1-2 years Case management experience required and
- 1-2 years UM or related experience required and
- 3-4 years Diverse clinical experience required
Licenses and Certifications
- RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia and/or the State of Maryland based on work location(s) Upon Hire required and
- CCM - Certified Case Manager Upon Hire preferred
Knowledge Skills and Abilities
- Verbal and written communication skills. Ability to use computer to enter and retrieve data. Ability to create edit and analyze Microsoft office (Word Excel and PowerPoint) preferred.
Do you currently have an opportunity to make a real impact with your work? With over 2,000 sites of care and serving over 31.2 million patient interactions every year, nurses at Valley Regional Medical Center have the opportunity to make a real impact. As a(an) Registered Nurse RN Case Manager you can be a part of change.
BenefitsValley Regional Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:
- Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
- Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.
- Free counseling services and resources for emotional, physical and financial wellbeing
- 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)
- Employee Stock Purchase Plan with 10% off HCA Healthcare stock
- Family support through fertility and family building benefits with Progyny and adoption assistance.
- Referral services for child, elder and pet care, home and auto repair, event planning and more
- Consumer discounts through Abenity and Consumer Discounts
- Retirement readiness, rollover assistance services and preferred banking partnerships
- Education assistance (tuition, student loan, certification support, dependent scholarships)
- Colleague recognition program
- Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)
- Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential and see how rewarding it can be to reach your personal and professional goals. Help to advance the practice of nursing and improve positive outcomes for your patients as a (an) Registered Nurse RN Case Manager. We want your knowledge and expertise!
Job Summary and QualificationsWe are seeking a RN Case Managerfor our facility to ensure that we continue to provide all patients with high quality, efficient care. We are an amazing team that works hard to support each other, and we are seeking a phenomenal addition like you who feels patient care is as meaningful as we do. We want you to apply now!
What You Will Do In Your Role:
- You will be responsible for promoting patient-centered care by coordinating all aspects of hospital-based case management for his/her assigned area of responsibility in alignment with the goals of the Case Management Department
- You will be accountable for the overall day-to-day oversight and management of the case management program including coordination, supervision, and administrative oversight of the case management team
- You will function as an expert clinical practitioner, case management subject-matter expert, resource, advisor and leader for the members of the case management team
- You will supervise and monitor professional and support staff and ensures that effective care coordination and case management practices are consistent with hospital policies, and applicable regulations and guidelines
- You will coordinate activities that promote quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resource utilization
- Basic Cardiac Life Support must be obtained within 30 days of employment start date
- (RN) Registered Nurse
- Masters Degree, or Bachelors Degree, or Associate Degree
- 3+ years of RN experience in an acute care setting
- Case Management experience preferred
Founded as Valley Community Hospital in 1975, Valley Regional Medical Center proudly serves Brownsville, TX and the surrounding communities in the Rio Grande Valley. Valley Regional Medical Center is a licensed 215+ bed facility with over 200 physicians representing 25+ specialties. From emergency medicine, to diagnostic imaging services, and caring for newborn babies, Valley Regional Medical Center is the hospital that families count on when they are looking for quality healthcare close to home. We are a designated Advanced Level III Trauma Center and an Advanced Primary Stroke Center. Our Heart and Vascular services include a full-range of cardiac services including minimally invasive and open-heart surgery, cardiac cath lab, heart imaging services and more. Our women’s department includes labor, delivery and recovery in a home-like setting. We also have a C-section operating room on standby 24 hours a day and a Level III Neonatal Intensive Care Unit equipped with specially trained staff. Innovation and an unwavering commitment to patient care are the cornerstones of our hospital. Come experience our family centered culture at Valley Regional.
HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
Be a part of an organization that leverages our size to make a real impact in our industry! Our Talent Acquisition team is reviewing applications for our Registered Nurse RN Case Manager opening. Submit your application today and help advance the practice of nursing.
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
Job Summary
The Manager of Case Management is responsible and accountable to assist the Director of Case Management in the implementation of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, Utilization Management, Case Management and Discharge Planning.The Manager is responsible for coordinating the use systems and processes for care/utilization management at the hospital level. In addition, the Manager is responsible for to assist the Director in managing the department’s activities related to discharge planning and clinical quality improvement. The Manager coordinates day to day departmental operations and the use of hospital resources appropriately and effectively. The Manager participates in the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement.Job Description
Minimum Qualifications
Education: Bachelors of Science in Nursing OR Social Work (BSW). Master’s degree preferred*
*Note: effective March 1, 2019 and going forward, these are the minimum qualifications for this role; incumbents hired before March 1, 2019 may have commensurate experience in lieu of BSN.
Licenses/Certifications:
Current and valid license to practice as a Registered Nurse in the state of Texas or
Licensed Master Social Worker (LMSW) required, LCSW preferred
Case Manager Certification required
Experience/ Knowledge/ Skills:
Minimum five (5) years experience in utilization management, case management, discharge planning or other cost/quality management program
Three (3) years of experience in hospital-based nursing or social work
Three (3) years of demonstrated leadership experience
Knowledge of leading practice in clinical care and payor requirements
Self-motivated, proven communication skills, assertive
Background in business planning, and targeted outcomes
Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management
Working knowledge of the concepts associated with Performance Improvement
Demonstrated effective working relationship with physicians
Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes
Effective oral and written communication skills
Principal Accountabilities
Assists in supervising and managing all aspects of the local level program.
Supports growth and development of the case management program consistent with enterprise wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed.
Responsible for coordinating day to day operations of the program at the unit level.
Assists in identifying and achieving optimal targeted financial outcomes via the inpatient case management process.
Participates in departmental personnel functions (hiring, firing, etc.) in conjunction with the Director of Case Management.
Provides input to annual and interim performance appraisal reviews for the professional and non-professional staff in department.
Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospitalists, community care managers, nurses, community resources, etc.)
Responsible for leading a high performance team of “system thinkers” who incorporate leadership principles and vision in performing the functions of case management.
Uses data to drive decisions, plan, and implement performance improvement strategies for case management.
Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
Other duties as assigned.
At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
Job Summary
The Manager of Case Management is responsible and accountable to assist the Director of Case Management in the implementation of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, Utilization Management, Case Management and Discharge Planning.The Manager is responsible for coordinating the use systems and processes for care/utilization management at the hospital level. In addition, the Manager is responsible for to assist the Director in managing the department’s activities related to discharge planning and clinical quality improvement. The Manager coordinates day to day departmental operations and the use of hospital resources appropriately and effectively. The Manager participates in the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement.Job Description
Minimum Qualifications
Education: Bachelors of Science in Nursing OR Social Work (BSW). Master’s degree preferred*
*Note: effective March 1, 2019 and going forward, these are the minimum qualifications for this role; incumbents hired before March 1, 2019 may have commensurate experience in lieu of BSN.
Licenses/Certifications:
Current and valid license to practice as a Registered Nurse in the state of Texas or
Licensed Master Social Worker (LMSW) required, LCSW preferred.
Case Manager Certification required.
Experience/ Knowledge/ Skills:
Minimum five (5) years experience in utilization management, case management, discharge planning or other cost/quality management program.
Three (3) years of experience in hospital-based nursing or social work.
Three (3) years of demonstrated leadership experience.
Knowledge of leading practice in clinical care and payor requirements.
Self-motivated, proven communication skills, assertive.
Background in business planning, and targeted outcomes.
Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management.
Working knowledge of the concepts associated with Performance Improvement.
Demonstrated effective working relationship with physicians.
Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.
Effective oral and written communication skills.
Principal Accountabilities
Assists in supervising and managing all aspects of the local level program.
Supports growth and development of the case management program consistent with enterprise wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed.
Responsible for coordinating day to day operations of the program at the unit level.
Assists in identifying and achieving optimal targeted financial outcomes via the inpatient case management process.
Participates in departmental personnel functions (hiring, firing, etc.) in conjunction with the Director of Case Management.
Provides input to annual and interim performance appraisal reviews for the professional and non-professional staff in department.
Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospitalists, community care managers, nurses, community resources, etc.).
Responsible for leading a high performance team of “system thinkers” who incorporate leadership principles and vision in performing the functions of case management.
Uses data to drive decisions, plan, and implement performance improvement strategies for case management.
Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
Other duties as assigned.
At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
Job Summary
The Manager of Case Management is responsible and accountable to assist the Director of Case Management in the implementation of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, Utilization Management, Case Management and Discharge Planning.The Manager is responsible for coordinating the use systems and processes for care/utilization management at the hospital level. In addition, the Manager is responsible for to assist the Director in managing the department’s activities related to discharge planning and clinical quality improvement. The Manager coordinates day to day departmental operations and the use of hospital resources appropriately and effectively. The Manager participates in the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement.Job Description
Minimum Qualifications
Education: Bachelors of Science in Nursing OR Social Work (BSW). Master’s degree preferred*
*Note: effective March 1, 2019 and going forward, these are the minimum qualifications for this role; incumbents hired before March 1, 2019 may have commensurate experience in lieu of BSN.
Licenses/Certifications:
Current and valid license to practice as a Registered Nurse in the state of Texas or
Licensed Master Social Worker (LMSW) required, LCSW preferred
Case Manager Certification required
Experience/ Knowledge/ Skills:
Minimum five (5) years experience in utilization management, case management, discharge planning or other cost/quality management program
Three (3) years of experience in hospital-based nursing or social work
Three (3) years of demonstrated leadership experience
Knowledge of leading practice in clinical care and payor requirements
Self-motivated, proven communication skills, assertive
Background in business planning, and targeted outcomes
Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management
Working knowledge of the concepts associated with Performance Improvement
Demonstrated effective working relationship with physicians
Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes
Effective oral and written communication skills
Principal Accountabilities
Assists in supervising and managing all aspects of the local level program.
Supports growth and development of the case management program consistent with enterprise wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed.
Responsible for coordinating day to day operations of the program at the unit level.
Assists in identifying and achieving optimal targeted financial outcomes via the inpatient case management process.
Participates in departmental personnel functions (hiring, firing, etc.) in conjunction with the Director of Case Management.
Provides input to annual and interim performance appraisal reviews for the professional and non-professional staff in department.
Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospitalists, community care managers, nurses, community resources, etc.)
Responsible for leading a high performance team of “system thinkers” who incorporate leadership principles and vision in performing the functions of case management.
Uses data to drive decisions, plan, and implement performance improvement strategies for case management.
Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
Other duties as assigned.
At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
Job Summary
The Manager of Case Management is responsible and accountable to assist the Director of Case Management in the implementation of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, Utilization Management, Case Management and Discharge Planning.The Manager is responsible for coordinating the use systems and processes for care/utilization management at the hospital level. In addition, the Manager is responsible for to assist the Director in managing the department’s activities related to discharge planning and clinical quality improvement. The Manager coordinates day to day departmental operations and the use of hospital resources appropriately and effectively. The Manager participates in the collection, analysis and reporting of financial and quality data related to utilization management, quality improvement and performance improvement.Job Description
Minimum Qualifications
Education: Bachelors of Science in Nursing OR Social Work (BSW). Master’s degree preferred*
*Note: effective March 1, 2019 and going forward, these are the minimum qualifications for this role; incumbents hired before March 1, 2019 may have commensurate experience in lieu of BSN.
Licenses/Certifications:
Current and valid license to practice as a Registered Nurse in the state of Texas or
Licensed Master Social Worker (LMSW) required, LCSW preferred.
Case Manager Certification required.
Experience/ Knowledge/ Skills:
Minimum five (5) years experience in utilization management, case management, discharge planning or other cost/quality management program.
Three (3) years of experience in hospital-based nursing or social work.
Three (3) years of demonstrated leadership experience.
Knowledge of leading practice in clinical care and payor requirements.
Self-motivated, proven communication skills, assertive.
Background in business planning, and targeted outcomes.
Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management.
Working knowledge of the concepts associated with Performance Improvement.
Demonstrated effective working relationship with physicians.
Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes.
Effective oral and written communication skills.
Principal Accountabilities
Assists in supervising and managing all aspects of the local level program.
Supports growth and development of the case management program consistent with enterprise wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed.
Responsible for coordinating day to day operations of the program at the unit level.
Assists in identifying and achieving optimal targeted financial outcomes via the inpatient case management process.
Participates in departmental personnel functions (hiring, firing, etc.) in conjunction with the Director of Case Management.
Provides input to annual and interim performance appraisal reviews for the professional and non-professional staff in department.
Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospitalists, community care managers, nurses, community resources, etc.).
Responsible for leading a high performance team of “system thinkers” who incorporate leadership principles and vision in performing the functions of case management.
Uses data to drive decisions, plan, and implement performance improvement strategies for case management.
Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
Other duties as assigned.
This hybrid role allows candidates to work primarily from home while completing occasional in-person member visits in their local area as needed.
As part of the Integrated Care Management (ICM) team, the Case Manager works with members who have complex health and social needs.
Through collaboration, the Case Manager helps coordinate services and advocate for appropriate care to improve health outcomes and promote cost-effective care solutions.
Key Responsibilities Conduct comprehensive assessments of members’ health, social, and care coordination needs.
Develop and implement individualized case management plans based on member needs, benefit plans, and available resources.
Collaborate with members, healthcare providers, and community organizations to coordinate services and support care plans.
Apply clinical guidelines, policies, and regulatory standards to ensure appropriate benefit utilization and care management.
Utilize clinical tools and data review to evaluate member eligibility and determine appropriate care strategies.
Advocate for members by identifying resources and coordinating services to address medical and social determinants of health.
Maintain accurate documentation while navigating multiple systems and case management platforms.
Participate in care management and quality management processes in compliance with regulatory and accreditation standards.
Caseload Information Telephonic/Hybrid Case Managers: Caseloads typically range from 250–500 members , depending on stratification and complexity of member needs.
Field-Based Case Managers: Caseloads typically range from 30–100 members , depending on market needs and complexity.
Required Skills & Qualifications Active, unrestricted Illinois license required: RN, LCSW, or LCPC.
Minimum 3–5 years of clinical experience required.
2–3 years of care management, discharge planning, or home health coordination experience preferred.
Experience working with case management processes and care coordination programs preferred.
Experience with Illinois waiver services preferred.
Ability to work independently in a remote/home-based environment while collaborating with teams virtually.
Proficiency with Microsoft Office (Word, Excel, Outlook, PowerPoint) and ability to navigate multiple systems.
Education Active Illinois licensure required as one of the following: Registered Nurse (RN) Licensed Clinical Social Worker (LCSW) Licensed Clinical Professional Counselor (LCPC) Keywords: case management, care coordination, discharge planning, RN case manager, LCSW case manager, LCPC case manager, managed care, Medicare, Medicaid, integrated care management, telephonic case management, hybrid case manager, population health, healthcare coordination, care management
Remote working/work at home options are available for this role.
In this role, you will perform comprehensive patient assessments, develop individualized care plans, and collaborate with providers and care teams to ensure members receive appropriate, cost-effective care.
The RN Case Manager plays a key role in supporting patient transitions, coordinating services, and advocating for patient needs while ensuring compliance with treatment plans and promoting positive health outcomes.
Key Responsibilities Perform comprehensive assessments of high-risk patients to evaluate clinical and social care needs.
Develop and implement individualized care plans in collaboration with primary care providers and healthcare teams.
Coordinate care transitions between providers, facilities, and community resources.
Collaborate with physicians, social workers, discharge planners, and claims professionals to ensure appropriate levels of care.
Identify and coordinate non-medical support services such as housing or transportation to support treatment compliance.
Engage specialty resources and community services as needed to improve patient outcomes.
Maintain detailed documentation of clinical, functional, and financial outcomes throughout the case management process.
Identify opportunities for health promotion and illness prevention.
Prevent adverse patient events whenever possible and intervene quickly to minimize negative outcomes.
Performance Expectations Case management benchmark of 30 cases per week (Monday-Friday).
Required Qualifications Current, unrestricted Registered Nurse (RN) license.
Associate’s or Bachelor’s Degree in Nursing or related field.
Experience with Home Care Home Base (HCHB), PointCare, or PointClickCare systems.
Case Management Certification preferred.
Proficiency with Microsoft Teams and other technology platforms.
Keywords: RN case manager, nurse case manager, care coordination, patient advocacy, discharge planning, care transitions, population health, home health case management, utilization management, HCHB, PointClickCare, PointCare, clinical case management, healthcare coordination
