Description

JOB SUMMARY

At Houston Methodist, the Manager Case Management & Social Services RN position is responsible for functional and operational aspects of the Case Mgmt./Social Work department, an integrated, interprofessional department which supports caregivers to provide the highest quality, most clinically appropriate care to patients and while promoting the most cost-effective utilization of the hospital's resources. This position maintains accountability for level of unit performance and results, possessing the ability to interact with corporate and hospital administrators, medical staff, and defined customers related to the Case Mgmt. system. The Manager Case Mgmt./Social Work position is responsible for the Case Mgmt. reporting system to ensure organization priorities are appropriately addressed in all facilities.

The manager position responsibilities include managing the daily work activities of the work unit/department staff, ensuring quality, productivity, functional excellence and efficiency while assisting management in accomplishing strategic and operational objectives. In addition, this position provides guidance to staff and is responsible for staffing, budget compliance, contributing to staffing decisions such as hiring and terminating employment, coaching and counseling employees on work related performance, and assisting in the development and implementation of policies and procedures to ensure a safe and effective work environment. This position also implements training, monitoring and operations initiatives that secure compliance with ethical and legal business practices and accreditation/regulatory/ government regulations.

 ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

Performs management responsibilities of selection, scheduling, supervision, retention, and evaluation of employees in the department. Provides development and mentoring of staff. Meets or exceeds threshold goal for department turnover. Develops direct reports to perform these same functions. 
Provides fair and consistent leadership and communication to maintain a competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees, completing performance appraisals, conducting new hire feedback sessions, coaching/corrective counseling, and providing recognition/commendations to achieve desired outcomes. Provides timely guidance and feedback to help others strengthen specific knowledge/skill areas needed to accomplish a task or solve a problem. 
Facilitates and promotes effective team dynamics and teambuilding strategies within and between departments; participates and/or leads and facilitates department process improvements as needed. 
Meets or exceeds threshold goal for department and/or system metrics on employee engagement indicators. 
Provides leadership to ensure operational effectiveness and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and exceed service-level goals and contract requirements. 

SERVICE ESSENTIAL FUNCTIONS

Plans and organizes day-to-day department operations, schedule and activities. Sets priorities and functional standards, giving direction to staff as necessary to ensure the best possible delivery of service and high customer/patient satisfaction. 
Drives department service standards and activities to impact department and/or system score for patient/customer-based satisfaction, through role modeling and fostering accountability. Serves and actively participates on various entity committees as a voice for the department. 
Makes and executes decisions within delegated authority. Escalates issues to management for resolution as appropriate. Participates in resolving issues outside delegated scope of authority. 
Maintains ongoing interactions with physicians and staff on how to improve patient care and service provided. Manages administrative issues effectively and timely, as well as, informs and provides pertinent information to physicians. 

QUALITY/SAFETY ESSENTIAL FUNCTIONS

Ensures a safe and effective working environment; monitors and/or revises the department safety plan and/or any specific accreditation/regulatory required safety guidelines, including infection control principles. Monitors and confirms staff maintain their required credentials that demonstrate competency per accrediting agency or department guidelines as applicable. 
Uses and optimizes information systems to enhance operations; supports entity-specific performance improvement and data management/analysis functions. 
Employs a proactive approach in the optimization of safe outcomes by monitoring and improving the department workflow, using peer-to-peer accountability, reporting accidents, near misses, and/or adverse events immediately per department protocol and identifying solutions via collaboration. Adopts LEAN principles in driving process improvements. Role models situational awareness, using teachable moments to improve safety. 
Monitors self and employee compliance with policies, procedures, and System HR Standards of Practice and performs associated actions upon non-compliance (i.e., focal point review requirements, disaster plan, inservices, influenza immunization, wage and hour, standard hours, timely termination submission, timely timecard approval, etc.). 
Supports maximization of Case Mgmt. system utilization, including length of stay (LOS), readmissions, and other KPIs as set by the organization. Strategizes and negotiates with the interprofessional team, patient and family, providers and payors about the care provided and the best course of action. Promotes self-care activities, autonomous decision making, active patient and family participation in treatment/care planning and health promotion. 
Generates reports to identify trends and opportunities for process improvement. Develops audit reports to identify quality issues and areas for enhanced staff training. Evaluates department procedures and operations as they relate to care coordination and recommends changes to improve efficiency and effectiveness as appropriate. 
Oversees the quality assurance and quality improvement processes related to admission, concurrent and retrospective UM and medical claims programs. Collaborates with medical and clinical leadership to implement new processes for enhancing service levels. 
Proactively identifies case management and/or social work interventions and implements role descriptions and priority expectations to improve care coordination metrics (LOS reduction, discharges before 11am, readmission reduction, and other KPIs.). 

FINANCE ESSENTIAL FUNCTIONS

Assists in the development of department budget and ensures that the department operates in a cost effective manner. Manages/audits department expenses within approved budget parameters, ensuring that the department meets the budgeted/flex revenue and/or expense targets on a monthly and annual basis. Develops staffing plans and schedules to meet department/patient needs that reflect understanding of the importance of cost-effectiveness. 
Implements department strategies to achieve financial target and staffing needs, developing others to do the same, through optimizing productivity, supply/resource efficiency, minimizing incidental overtime and overtime percentage, and other areas according to department specifications. 
Manages utilization management (UM) programs including Medical Claims Review, Precertification and Reconsiderations and Appeals. Collaborates with the Director of Case Management/Social Svcs on criteria and policy and procedure development. Collaborates with Physician and Nursing leaders and external entities to develop, implement and evaluate UM programs and policies as directed and ensures UM programs are consistent with national accreditation guidelines. 

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

Identifies and implements innovative solutions for practice or workflow changes to improve department operations or other department-specific measures by leading unit projects and/or other department/system directed/shared governance activities. Supports change initiatives, maintaining effectiveness when experiencing major changes in work responsibilities or environment; adjusts effectively to work within new work structures, processes, requirements or cultures. 
Proactively evaluates processes; recommends and implements action plan(s) for change; follows through to ensure effective, sustainable change. Participates in the development and implementation of new procedures and the review and revision of existing procedures. 
Identifies opportunities and takes action to build strategic relationships between one’s area and other areas, teams, departments, and units to achieve business goals. 
Seeks opportunities to identify developmental needs of self and staff and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates My Development Plan (MDP) on an on-going basis. Conducts conversations with staff on their development. 
Recommends appropriate uses for the Case Management system, coordinating initial training for new users and ongoing training department staff of system upgrades, changes, and new functions as necessary. 

Requirements

QUALIFICATIONS

EDUCATION

Bachelor’s degree or higher from an accredited school of Nursing 
Master’s in nursing preferred 

EXPERIENCE

Five years’ experience in inpatient case management, social work or utilization management or in the managed care/payer environment, of which one year must have been in a people management role in healthcare; for HM candidates, four years’ experience in case management or social work, which includes HM performance that demonstrates progressive leadership abilities 

LICENSES AND CERTIFICATIONS
Required

RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency) and
Magnet ANCC-recognized Case Management Certification: ACHPN-HPCC or CCM or CMC or ACM-NBCM or CDCES or CHPN-HPCC or CMGT-BC or CM-ABOHN or CMCN or ANCC-NCM within 1 year