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Case Manager

Case Manager

MyCare Medical GroupHouston, TX, US
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POSITION SUMMARY :

  • MyCare Medical Group is a healthcare organization committed to delivering the highest quality, most cost-effective care to its patients.  We are looking for an experienced Case Manager , who will be responsible for promoting patient-centered care by coordinating all aspects of inpatient / outpatient-based case management for his / her assigned area of responsibility in alignment with the goals of the Case Management Department.
  • The Case Manager is accountable for the overall day-to-day monitoring of ancillary clinics to include care coordination, subject-matter expert, and resource advisor.
  • Our Case Manager functions as an extension to ancillary provider clinics, monitoring and ensures that effective care coordination and case management practices are consistent with MyCare policies.

RESPONSIBILITIES :

  • Daily review of Hospital and Skill Nursing Home inpatient list; considers patient’s readmission status or risk of readmission and develops strategies to mitigate including education on appropriately accessing healthcare resources, preventative education, and community-based resources.  This also includes : Daily updates from Hospital and / or Skilled Nursing Home (SNH) Case Managers Provide information to Hospital and / or SNH Case Manager Coordinate post in patient admission services and office follow up Obtain medical records from Hospital and / or SNH for office follow up Review of family dynamics and support systems Coordinate with Clinics & Providers with Care Team at Facilities any possible admissions and / or ER diversions to a Skilled Nursing Home Notify SNH admitting physician and Case Manager of any possible admissions and provide medical information as needed.
  • Maintain appropriate documentation in available systems EMR and any other CM software.
  • Contact high risk patients when they are no shows.
  • Document in the CM software the reason and reschedule.
  • Regularly interact with Clinic, Providers and their office Care Team to review elective / future inpatient and outpatient procedures.
  • This is to include :

  • Reviewing with the PCP Reviewing Pre-Op clearance w / office staff.
  • Notify UM / Quality Department Director of upcoming inpatient procedures.
  • Review all out of the area admissions and keep a daily report.
  • Daily review of office schedules to identify any patients that need Case Management intervention.
  • Recent Hospital / SNH discharges Disease Management Education on Advanced Directives, Community Services information Case Management System :

  • Maintain most current patients’ information.
  • Tracking system for Hospital / SNH admissions and Disease management To identify patients for Disease Management and follow up according to protocol CAD / CHF / COPD / DM / CKD Disease Management To manage conditions on monthly logs :

  • ESRD-End Stage Renal Disease Log : Form 2728 ESRD Medical Evidence Report Hospice Log Certification Forms Oncology Log Transplant Log CAD / CHF / COPD / Diabetes / CKD Disease Management Log To follow up protocols of : Case Management Disease Management Transitions of Care QUALIFICATIONS : Required Certifications : Must have a current Registered Nurse (RN) license within the State of Florida, in good standing Must have CPR / BLS certification Current Case Management Certification, or must be willing to obtain during employment; Case Manager must also maintain appropriate continuing education for case management and professional licensure Must be a patient advocate – Case Manager will be dedicated to patient advocacy, providing empowerment through knowledge and care.
  • Case Manager must guide their actions with ethical principles, providing service with respect for autonomy, dignity, privacy and rights of their patients.
  • Must have a clinical background, preferably within referral coordination, case screening and identification, or other similar positions.
  • Must have knowledge of state and federal law regulations that apply to various healthcare providers, including but not limited to :

  • Confidentiality and releases of information HIPAA Guidelines Ability to multitask and organize priority of work throughout the day, managing their time accordingly, and be flexible in a results-driven, fast-paced, growth oriented, emerging company.
  • Excellent computer skills, specifically with Microsoft Office (Office 365) applications (Outlook, Excel, Word).
  • Must have excellent verbal and written communication skills; this position relies heavily on collaboration through consistent and thorough presentation of pertaining information.
  • Ability to self-direct and work autonomously and independently; Must also work with a team, negotiating and collaborating various solutions, including leading presentations during conferences and meetings.
  • Detail-oriented with strong analytical, critical-thinking, and problem-solving skills.   Powered by JazzHR
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    Case Manager • Houston, TX, US

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