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Work Schedule/Shift

8AM - 5PM

Req. No

13990

Job Title

Case Manager

Market

CHRISTUS System Office

Category

Social Services

Facility

CHRISTUS Corp Irving Offices 919 and 909 Buildings

Address

919 Hidden Ridge
Irving, TX  75038
USView Other Locations

Type

FULL TIME

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Summary:

The Case Manager identifies, evaluates, and provides management of services for patients with complex, catastrophic, long term illness or injury, targeted diseases, as well as those patients receiving out of network services.To promote quality, cost-effective outcomes throughout the care continuum, the Case Manager will utilize ongoing nursing process and critical thinking skills to administer all facets of the case management process including assessment, planning, development of nursing diagnoses and care plans with subsequent revisions, organization and implementation of the nursing plan of care, coordination and oversight of services, and evaluation of options and services.The Case Manager acts as a member advocate to coordinate and collaborate care with physicians, family, and other providers, or to implement creative solutions to meet member’s health care needs without compromising quality of outcomes. The position responsibilities also include reducing LOS of hospitalization by initiating early discharge planning to quality, cost-effective alternative settings.

  • Perform ongoing essential Case Management activities of assessment, problem identification, planning, implementation, coordination, monitoring, and evaluation of case managed members
  • Develop, implement, evaluate and revise case management treatment plans according to CM eligibility criteria, contractual guidelines and member’s physical and psychological needs throughout the continuum of care
  • Engage in ongoing timely professional collaboration and communication with the member, member’s family and/or caregivers and healthcare providers according to member’s healthcare needs to enhance positive outcomes
  • Monitor ongoing services from providers caring for members
  • Coordinate plan of care for patients with catastrophic needs or those receiving care throughout of network providers,within required governmental and contractual guidelines
  • Establish and maintain rapport with providers as well as ongoing education of providers concerning appropriate protocol
  • Facilitate negotiations for out of network care
  • Collaborate with all other departments as appropriate and required to facilitate the completion of tasks/goals
  • Perform telephonic communication with members in case management according to member needs and within Department of Defense contractual time frames
  • Contact the provider of services and/or case managed member within one (1) business day to confirm initiation of requested items/services considered time sensitive (i.e. O2, IV therapy, walker post knee surgery, etc and within two (2) business days for other requested items/services (i.e. routine DME, Home Health, etc
  • Facilitate patient wellness and autonomy through advocacy, communication, education, and identification of service resources
  • Identify appropriate providers and facilities through the continuum of services, and ensure that available resources are being used in a timely and cost effective manner
  • Maintain quality documentation of collected data, actions taken, and results of actions taken in order to promote continuity of care within governmental and contractual requirements
  • Collaborate with onsite case managers and telephonic care managers in the discharge planning process, obtaining and/or coordinating appropriate resources for patients along the continuum of the health care system
  • Identify and present all cases of possible quality deviation, questionable admissions, prolonged length of stays, and out of network services to physician review for determination
  • Acquires data and evaluates necessary medical services for cost containment
  • Provide backup coverage for other Case Managers, Care Managers, and Referral/Pre-certification Nurses
  • Collaborate with all other departments as appropriate and required to facilitate completion of tasks/goals
  • Self starter with ability to handle multiple projects at one time.
  • Demonstrated organizational, time management, prioritization and team work skills
  • Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
  • Adhere to URAC standards
  • Communication, Collaboration, and Coordination with customers, internal and external
  • Present and/or facilitate one departmental in-service per calendar year
  • Attend monthly departmental staff meetings and/or interdepartmental meetings as appropriate
  • Analytic ability to prepare status reports and document procedures
  • Excellent communication skills, judgment, initiative,critical thinking and problem solving abilities
  • Ability to handle and resolve complex issues
  • Ability to work occasional long or irregular hours
  • Ability to work a flexible work schedule 

Requirements:

  • Graduate of an accredited Registered Nursing program, Bachelor Degree preferred
  • Graduate of Social Work Program, MSW preferred
  • Basic knowledge of computer systems
  • Good typing skills
  • Excellent customer service skills
  • Excellent negotiation skills
  • Minimum three years diverse clinical experience as a RN or Social Worker
  • Minimum two years case management and/or utilization review experience
  • Current/Active Texas RN Licensure or
  • Current/Active Texas Social Work Licensure
  • Certification in Case Management or Chronic Care Professional preferred

Work Type: 

Full Time


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