Case Manager RN, LMSW PRN

About the position The Case Manager II Part Time at Kindred Hospital Houston Northwest is responsible for coordinating and facilitating the care of patients through effective collaboration with the Interdisciplinary Care Transitions (ICT) team members. This role involves following patients throughout their continuum of care, ensuring optimal utilization of resources, service delivery, and compliance with external review agencies. The Case Manager provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation, and overall evaluation of individual patient needs. The primary goal is to enhance the quality of patient management and satisfaction, promoting continuity of care and cost-effectiveness by integrating the functions of case management, utilization review, and discharge planning. In this position, the Case Manager will coordinate clinical and psycho-social activities with the Interdisciplinary Team and Physicians, monitor all areas of patients' stays for effective care coordination, and remain knowledgeable about reimbursement modalities, community resources, and legal issues affecting patients and providers. The Case Manager serves as a patient advocate, enhancing collaborative relationships to empower patients and families in making informed decisions. Participation in interdisciplinary patient care rounds and conferences is essential to review treatment goals, optimize resource utilization, and provide family education regarding post-hospital needs. The role also includes conducting comprehensive assessments for timely and safe discharge planning, utilizing critical thinking to develop effective discharge plans, and ensuring efficient communication with patients and families. Additionally, the Case Manager will conduct medical necessity reviews for appropriate utilization of services from admission through discharge, promoting effective use of clinical resources and coordinating continued stay authorization with payors. Responsibilities • Coordinates clinical and/or psycho-social activities with the Interdisciplinary Team and Physicians. , • Monitors all areas of patients' stay for effective care coordination and efficient care facilitation. , • Remains current regarding reimbursement modalities, community resources, case management, psychosocial and legal issues that affect patients and providers of care. , • Appropriately refers high risk patients who would benefit from additional support. , • Serves as a patient advocate, enhancing collaborative relationships to maximize the patient's and family's ability to make informed decisions. , • Demonstrates knowledge of growth and development principles to provide age-appropriate care to the patient population served. , • Participates in interdisciplinary patient care rounds and/or conferences to review treatment goals and optimize resource utilization. , • Coordinates with interdisciplinary care team, physicians, patients, families, post-acute providers, payors, and others in planning patients' care throughout the care continuum. , • Conducts comprehensive, ongoing assessment of patients to provide timely and safe discharge planning. , • Provides comprehensive discharge planning for each patient, utilizing critical thinking to develop and execute effective plans. , • Conducts medical necessity review for appropriate utilization of services from admission through discharge. , • Promotes effective and efficient utilization of clinical resources. Requirements • Graduate of an accredited program required: RN, BSN preferred OR Master of Social Work with licensure as required by state regulations OR Bachelor of Social Work with licensure as required by state regulations. , • Healthcare professional licensure required as Registered Nurse or Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW) if required by state regulations. , • Certification in Case Management preferred. , • Two years of experience in a healthcare setting preferred. , • Prior experience in case management, utilization review, or discharge planning is preferred. , • Knowledge of government and non-government payor practices, regulations, standards, and reimbursement. , • Knowledge of Medicare benefits and insurance processes and contracts. , • Knowledge of accreditation standards and compliance requirements. Nice-to-haves

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