Hospital - Lead Case Manager

UT Health San Antonio•San Antonio, TX

1d•Onsite

About The Position

Under minimal supervision, manages cases to enhance the quality of patient management and satisfaction. Promotes continuity of care and cost effectiveness through integrating functions of case management, utilization review and management, and discharge planning. Functions as a subject matter expert in areas that significantly enhance care delivery such as staff education, policy development, quality assurance and/or leadership. Will provide continued support to care management team.

Requirements

Strong problem-solving skills, with the ability to address and resolve issues related to patient care and care management processes. Capable of making informed decisions based on data, clinical guidelines, and best practices.
Strong organizational and time-management skills, with the ability to prioritize tasks and manage multiple responsibilities.
Excellent verbal and written communication skills, with the ability to convey complex information clearly and effectively to patients, families, and healthcare providers.
Strong interpersonal skills, with the ability to build and maintain positive relationships with diverse stakeholders.
Ability to analyze data, identify trends, and use information to drive improvements in care management processes and patient outcomes. Proficiency in using electronic health records (EHR) systems and other healthcare software.
Understanding of healthcare regulations, accreditation standards, and compliance requirements relevant to care management and utilization review. Familiarity with payer requirements and reimbursement processes.
Current Texas Board of Nursing (or Compact State) RN license; Or a Temporary Texas RN License (Permanent TX license within 90 days upon hire).

Responsibilities

Promotes and demonstrates the professional image of care management in demeanor, appearance, attitude, and behavior.
Conduct utilization reviews to ensure medical necessity, appropriateness, and efficiency of healthcare services. Address and resolve any issues related to care coordination, including gaps in services or communication barriers.
Develop and update policies and procedures related to care management to ensure they align with best practices and regulatory requirements.
Covers departmental operations as requested or in the absence of the Director of Care Management.
Oversee the coordination of patient care, including discharge planning and transitions of care. Collaborate with other departments and stakeholders to integrate quality improvement efforts across the organization.
Ensure that all care management activities comply with hospital policies, regulatory standards, and accreditation requirements.
Serve as a liaison between patients, families, and the healthcare team, addressing any concerns or questions related to care and treatment. Provide guidance and support to patients and families regarding care options, resources, and follow-up plans.
Collect, analyze, and interpret data related to care management processes and patient outcomes. Prepare and present reports on care management activities, performance metrics, and program effectiveness to senior leadership.
Identify and address any resource needs or gaps within the care management team, including staffing, technology, and support services.
Advocate for patients’ needs and preferences, ensuring their voices are heard and their care preferences are respected. Address any issues related to patient rights, access to care, or ethical considerations in collaboration with the care team and hospital leadership. Provides directions in complex and unusual patient situations.