Nancy Guthrie Kidnapping Case Jobs in Usa
4,992 positions found
Position Summary:
Employee works with other members of the patient care team to deliver care to specific patient populations. The employee will maintain competency for population specific groups with consideration of physical, communication, safety, nutrition, and psychosocial needs.
Education, License & Cert:
High School Grad or Equivalent
Experience:
Must be currently enrolled in a practical nurse education and Guthrie's tuition sponsorship program for licensed practical nurses.
Essential Functions:
Participates in the delivery of patient care for population groups under the direction of an RN/LPN including but not limited to the following: • Lifting, turning, and positioning patients utilizing Safe Patient Handling equipment (> 35 pounds), as appropriate. • Observing confused and difficult patients • AM/PM Hygiene care • Toileting, shaving, washing, brushing hair, dental and mouth care • Feeding • Assisting with range of motion exercises • Mobilizing patients ‐ transfers and ambulation, utilizing Safe Patient Handling equipment (> 35 pounds), as appropriate and following the Mobility protocol • Exercise protocols • Discontinuing foley catheter (PA only) • Simple dressing changes • Incentive spirometry supervision • Surgical preps • Postmortem care • Administers cleansing enemas • Removal of peripheral IV catheters • Sits with confused/disoriented patients or those requiring 1:1 observation for safety/suicide purposes, as assigned • Performs and records accurately: • Temperature, pulse, respirations, blood pressure, heights and weights • I & O • Records bowel movements • ADLs and activities • Performs and records the following specimen collection: • Obtains urine, stool, and sputum specimens for patients; instructs patients in proper specimen collection technique. • Completes the following support activities. • Completes EKGs. • Transports patients as needed • Serves, sets up and retrieves trays • Distributes water pitchers as appropriate • Orders and distributes nourishment. • Transports equipment • Transports blood products to and from the patient care area. • Participates in patient safety/patient satisfaction. • Answers call bells • Participates in patient rounding • Reports any signs of abuse to the nursing staff • Recognizes, troubleshoots and initiates corrective action needed on equipment. • Maintains neat and tidy environment (empties laundry, delivers equipment, keeps patient rooms clean and safe). • Inventories and assures disposition of patients' belongings when admitted, transferred, and/or discharged. • Assures proper storage of equipment. • Recognizes emergency situations and initiates plan of action • Notifies RN/LPN of any changes seen in patient's condition • Complies with policies and procedures of the hospital/nursing department. • Supports the philosophy of the hospital and department of nursing. • Maintains CPR certification • Demonstrates cost‐effective patient care by demonstrating proper use and care of equipment, appropriate and prudent use of supplies, accurate charging of supplies; performing other division‐specific tasks, and appropriate utilization of available resources. • Participates in performance improvement activities to improve service and care. Demonstrates strong communication and organizational skills. • Ability to communicate using telephones, computer systems. • Answers telephone promptly and politely, identifying self, title, and department. Receives and sends messages in an accurate and timely fashion. • Communicates with the patients, family, and members of the healthcare team in a concise, tactful and considerate manner. Must represent the hospital in a professional courteous manner, while being sensitive to how others perceive both verbal and non‐verbal communications.
Other Duties:
• Assists in the orientation of new personnel and serves as a role model to other employees. • Demonstrates willingness to accept non‐routine work assignments as appropriate. • Encouraged to participate in community activities • Attends and participates in unit council (70% attendance).
Rev: 2-29-2024
Pay Range $17.00-$23.85/hr DOE
Hiring Senior Case Managers in New Mexico
PCM is looking for a Senior Case Manager who is as passionate about delivering care as we are to come join our amazing team!
A few of our perks:
Great Work/Life balance!
$42 per hour (including 100% of Hourly Wage Paid for Drive Time)
Benefits Available:
Medical, Vision and Dental Insurance
Accrued Paid Time Off
Annual Bonus Eligible
Health Savings Account (HSA)
Flexible Savings Account (FSA)
401(K) with Company Match
Paid Parental Leave
Unlimited Peer Referral Program
Employee Discount Program
We provide in-home care to former Nuclear Weapons Workers who are suffering from chronic and terminal illnesses, as a result of their previous work environment.
Our Senior RN-Case Managers Direct assigned team members of RN Case Managers in the provision of care in accordance with Agency policy and with state-specific nurse practice act, and regulatory requirements.
Qualifications
Graduate of a state approved school of professional registered nursing
BSN preferred
Current, unrestricted RN license in the state(s) of practice
Minimum of two (2) years nursing experience including one (1) year in home care or closely related field
One (1) year of supervisory and/or case management experience preferred
Current CPR certification
Essential Functions/Areas of Accountability
Responsible for functions and accountabilities as contained in the case manager job description
Provide direct care and case management of assigned clients
Assist and collaborate with the regional director and other personnel to identify and correct issues and/or improve services.
Plan, implement, and evaluate care provided Participate, coordinate and manage client care conferences as needed.
Serve as a local on-site clinical resource as needed and provides support to ensure client's home care needs are met.
Assist and collaborate with staffing coordinators regarding the appropriateness of staffing and scheduling of personnel within scope of practice, competencies, client needs and complexity of home care.
Adhere to nursing delegation guidelines as described in Agency Scope of Practice policy.
Ensure adherence to Agency policies.
Perform other functions as requested by the regional director which may include the following:
Participate in interviewing, selection, and ongoing evaluation of clinical personnel as requested by the Regional Director
Personnel training, education, and competency validation
Review and evaluate clinical documentation for accuracy and completeness
Participate in all Agency performance improvement initiatives including but not limited to quarterly medical record review
Collect, document, and submit data on infections, occurrences, complaints and grievances, and performance improvement activities
Perform and document supervisory visits as indicated to facilitate problem resolution
Review nurse shift reports for adherence to policy and for opportunities for performance improvement
Home chart completeness
Timeliness of staffing cases post referral
Equipment tracking
Assist with marketing activities such as visiting with clients or physicians to discuss Agency programs as requested
The senior case manager, or similarly qualified alternate, shall be available at all times during operating hours and participate in all activities relevant to the professional services furnished, including the development of qualifications and the assignment of personnel.
Perform additional duties and responsibilities as deemed necessary
Please contact Rick Carey at x350 or at today to learn more about our opportunities where you can make a difference in your own career!
Professional Case Management is an Equal Opportunity Employer.
SUMMARY:
- Palm Springs, CA
- Salary: $130,000 – $160,000 per year
- Hospital Setting
The individual in this position has overall responsibility for hospital utilization management, transition management and operational management of the Case Management Department in order to promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and 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 Tenet policy
- Education provided to physicians, patients, families and caregivers
The individual’s responsibilities include the following activities: a) manage department operations to assure effective throughput and reimbursement for services provided, b) lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement, c) ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policy, d) ensure timely and effective patient transition and planning to support efficient patient throughput, e) implement and monitor processes to prevent payer disputes, f) develop and provide physician education and feedback on hospital utilization, g) participate in management of post-acute provider network, h) ensure compliance with state and federal regulations and TJC accreditation standards, and i) other duties as assigned.
QUALIFICATIONS:
Required: Bachelor’s degree in business, Nursing or Health Care Administration for RN or master's in social work for MSW.
Preferred: MSN, MBA, MSW or MHA.
Required: 3 years of acute hospital case management or healthcare leadership experience.
Preferred: 5 years of acute hospital case management leadership multi-site experience
Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified, or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW/LMSW license for state(s) covered.
Preferred: Accredited Case Manager (ACM)
Text Nancy at 915-305-7508
Send your resume to
Send your resume to
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.
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
