A primary and secondary care hospital serving North Harris and
Montgomery counties. Clinical services include cardiovascular services,diagnostic imaging, women's services (digital mammography and bone densitystudies), neurosciences, pediatric care (Newborn and Level II nurseries) andsurgery, pathology and pulmonary services, and sleep disorders. Clinicalaffiliations include The University of Texas MD Anderson Cancer Center'sRadiation Treatment Center, and Texas Children's Hospital.
Coordinates patient care between patients, caregivers, and themultidisciplinary team; collects and evaluates information to facilitate careby assuring that admissions, continued stays, and ancillary services aremedically necessary, cost-effective, and providing the appropriate setting toqualify for reimbursement. The case manager intervenes when necessary toassure that case is care is coordinated and timely.
1.Documents on the day ofadmission, or within the first twenty four hours, a clinical assessment andanticipated discharge plan that addresses use of the full continuum of care
2.Provides plan of careupdates to providers inside and outside of the hospital, working with patientsand caregivers
3.Continually assesses andmodifies the plan of care based on clinical need and patient preference
4.Manages each patient'splan of care and throughout the stay
5.Leads interdisciplinaryrounds to coordinate care with the care team, and to address changes in thedischarge plan
6.Consults withappropriate physicians on plan of care and discharge
7.Remains current ofMedicare and Medicaid laws and guidelines, Medicare Conditions ofParticipation, managed care contracts, and other legal and regulatoryrequirements as they relate to health care case management services. Assures patients are informed of rights and responsibilities asparticipants in these programs.
Dependent on the facility the following responsibilities may berequired:
8.Identify and executedischarge planning needs determined through patient/significant other contact,chart reviews, health care team rounds and clinical pathways and protocols. Thecontinuum of care may extend from time of admission through the Rehabilitationphase.
9.Liaise with physicians,patient benefits, and third party payers to identify, reconcile and executenecessary actions for services rendered, ensuring appropriate services andreimbursement.
Bachelor'sDegree - Nursing OR ADN and 5 years of clinical experience
Three (3) years of clinical nursingexperience in the acute care or medical setting OR ADN and 5 years of clinicalexperience
MinimumKnowledge, Skills, and Abilities:
Clinical practice with experience acquired in assigned specialtyrequired
Computer skills required; must be able to document in medicalrecords
Exercises knowledgeable, independent judgment on routine andnon-routine matters
Requisition ID: 2019-R0214004
Shift: Day Job
Market: CHI St. Luke's Woodlands Hospital
Catholic Health Initiative