Case Manager (Nex)

Cook Children's Health Care System • Fort Worth, TX

126d

About The Position

The RN Case Manager (Nex) uses a collaborative process to plan, assess, implement, monitor and evaluate the options and services required to meet the healthcare needs of the patients using the functions of Utilization Review using Interqual and Milliman Care Guidelines, Discharge Planning and Case Management in order to facilitate: (1) quality of patient care; (2) cost effective utilization and outcome management; (3) communication between patients, families, and members of the health care team; (4) expedition of the movement of patients through appropriate levels of care; and (5) information gathering for Quality & Risk Management utilizing Joint Commission Accreditation of Healthcare standards and clinical indicators. The Case Manager will assist with the identification of appropriate providers and facilities throughout the continuum of care, to ensure that resources of both CCMC and the patient are used in a timely and cost-effective manner to meet the healthcare needs of the patient.

Requirements

• Associate degree in nursing is required.
• BSN from an accredited college or university is preferred.
• At least three years of experience in case management, care coordination, utilization review, patient intake, discharge planning, or related fields.
• Must be computer literate.
• Effective organizational, interpersonal, written, and oral communication skills.
• Familiarity with community resources and charitable organizations.
• Ability to adapt to changing healthcare environments.
• Experience using electronic medical records (e.g., EPIC, Meditech, Healthy Planet, etc.).
• Current RN license from Texas Board of Nursing required.
• Must achieve Basic Life Support (BLS) certification within 30 days of employment.

Nice To Haves

• Bilingualism is preferred or may be required depending on the specific department assignment.
• Health Plan Case Manager Certification (CCM) preferred.

Responsibilities

• Plan, assess, implement, monitor and evaluate healthcare options and services for patients.
• Utilize Interqual and Milliman Care Guidelines for Utilization Review.
• Facilitate quality of patient care and cost-effective utilization.
• Ensure effective communication between patients, families, and healthcare team members.
• Expedite patient movement through appropriate levels of care.
• Gather information for Quality & Risk Management.
• Assist in identifying appropriate providers and facilities for patient care.

What This Job Offers

• Job Type: Full-time
• Education Level: Associate degree