Registered Nurse Case Manager (RN) PRN

HCA Houston N Cypress
Cypress, TX
Competitive Salary
May 10, 2019
Aug 11, 2019
Case Management
Contract Type


HCA Houston Healthcare North Cypress - Cypress, Texas

Registered Nurse (RN) Case Manager - PRN

North Cypress is a 139 bed general acute care hospital, with a patient-friendly healthcare environment dedicated to their community. Our services include the latest, state-of-the-art medical technology and equipment, well-respected area physicians, and an upscale 5-star hotel-like ambiance. Designed with patients and physicians in mind, North Cypress aims to be the hospital of choice for the Northwest corridor.
As part of the HCA Healthcare network of affiliated facilities, North Cypress Medical Center is one of the nation's leading providers of healthcare services including:
• Breast Center
• Dialysis Center
• Oncology Services
• Emergency Services with 4 free-standing locations
• Heart Center
• Orthopedics
• Rehabilitation Services
• Sleep Center
• Sports Center
• Weight Loss Center
• Wound Care and Hyperbaric Medicine

North Cypress is currently looking for a Registered Nurse (RN) Case Manager.


Accountable for a designated patient caseload and plans effectively in order to meet patient needs, manage the length of stay, and promote efficient utilization of resources.
• Facilitation of precertification and payor authorization processes
• Facilitation of the collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement
• Application of process improvement methodologies in evaluating outcomes f care
• Support and coaching of clinical documentation efforts and serving as a clinical resource for coders ensuring that documentation accurately reflects severity of illness and intensity of service
• Coordinating communication with physicians.
Coordinates/facilitates patient care progression throughout the continuum.
• Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management.
• Addresses/resolves system problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge.
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
• Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load; monitors the patient's progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
• Facilitates the following on a timely basis
Completion and reporting diagnostic testing
Completion of treatment plan and discharge plan
Modification of plan of care, as necessary, to meet the ongoing needs of the patient
Communication to third party payors and other relevant information to the care team
Assignment of appropriate levels of care
Completion of all required documentation in IQ screens and patient records
Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.
Completes Utilization Management and Quality Screening for assigned patients.
• Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Department standards.
• Identifies at-risk populations using approved screening tool and follows established reporting procedures.
• Monitors LOS and ancillary resources use on an ongoing basis. Takes actions to achieve continuous improvement in both areas.
• Refers cases and issues to Care Management Medical Director in compliance with Department procedures and follows up as indicated.
• Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients. Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.
• Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.
Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.
Manages all aspects of discharge planning for assigned patients.
• Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician.
• Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching, and ongoing evaluation.
• Ensures/maintains plan consensus from patient/family, physician, and payor.
• Refers appropriate cases for social work intervention based on Department criteria.
• Collaborates/communicates with external case managers.
• Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment, and supplies.
• Documents relevant discharge planning information in the medical record according to Department standards.
• Facilitates transfer to other facilities as appropriate.
Actively participates in clinical performance improvement activities.
• Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials, and appeals.
• Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical, and patient satisfaction data.
• Collects, analyzes, and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team. Uses concurrent variance data to drive practice changes and positively impact outcomes.
• Collects delay and other data for specific performance and/or outcome indicators as determined by Director of Outcomes Management
• Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g. discharge planning). Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.
• Leads the development, implementation, evaluation, and revision of clinical pathways and other Case Management tools as a member of the clinical resource/team. Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction, and quality indicators (e.g., readmission rates, unplanned return to OR, etc.)
Acts as preceptor/mentor to new hires. Assists in development of orientation schedule and helps identify individual needs for learning.
Ensures safe care to patients adhering to policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization.

Position Qualifications:

Minimum Education:
Graduate of an accredited school of professional nursing.

Minimum Experience: 3-5 years strong clinical experience in clinical practice area, 1-3 years of previous Case Management experience

Required Licensure: RN in the State of Texas (BSN preferred) or LMSW (social worker) in the state of Texas

Required Certification: BLS, CCMC (Case Manager Certification)

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