RN Case Manager (PRN - as needed)
The Woman's Hospital of Texas- Houston - Houston, TX

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The RN Case Manager works with physicians and other members of the multidisciplinary team to develop a plan for each patient from admission to discharge. The tasks and responsibilities include: Performs continuous assessments and evaluations to ensure patient is progressing towards desired outcomes. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. Collaborates and consults with physicians on patient's progress and discharge planning needs. Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity. Manages the process to review and, as appropriate, appeal denials received from payors. Coordinates the discharge planning process ensuring involvement of all members of the healthcare team. Counsels with patients and family members in decision making and in meeting psycho social needs of the patient. Maintains knowledge of resources and facilities available to patients and family members. Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions. Compiles, evaluates, and reports statistics to members of the team and utilizes the information to facilitate process improvement activities. Provides age and culturally appropriate care. Orients and mentors new staff members. Follows Standard Precautions using personal protective equipment as required. Qualifications Required Job Qualifications include: Current licensure as an RN Graduate of an accredited school of professional nursing. Bachelor's of Science in Nursing REQUIRED CCM preferred Minimum 5 years of clinical nursing experience. Knowledge of CMS guidelines and experience working with payor specific guidelines and contractual rules preferred. Customer service abilities including effective listening skills. Critical thinking skills, decisive judgment and the ability to work with minimal supervision meeting firm deadlines. Assertive and persuasive communication skills, action oriented.
About this company
The Woman's Hospital of Texas opened in 1976, and has remained the state's premier facility dedicated to the health of women and newborns....