Case Management Rep

Overview

At Houston Methodist, the Case Management Representative position is responsible for providing clerical assistance and data management support to the case management and social work department to facilitate efficient utilization of resources and discharge planning including referrals management, communication and collaboration with post-acute care providers, access to agencies and other community resources and transportation. This position may perform some secretary duties and performs a wide variety of administrative duties of a higher complexity in support of Case Management operations. In addition, the CM Rep position performs independent actions necessary to provide competent and professional assistance to meet the needs of social workers/case managers and patients. This position also coordinates, oversees, records, and transmits information pertinent to the resource management of patients to next level of care providers.

Houston Methodist Standard

PATIENT AGE GROUP(S) AND POPULATION(S) SERVEDRefer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

Responsibilities

PEOPLE ESSENTIAL FUNCTIONS

• Serves as a department resource for questions related to case management activities. Communicates in an active, positive, and effective manner to all interprofessional health care team members. Reports pertinent patient care and family data in a comprehensive and unbiased manner. Performs phone call and communication triage, troubleshoots and routes issues to appropriate individuals, assists in resolution of non-clinical issues as needed

• Facilitates and arranges acquisition of post-acute needs, as directed, and in collaboration with the clinical team. Follows payor/reimbursement practices and regulations that may impact the patient's plan of care

• Provides appropriate and timely communication, update, and documentation to the referring personnel to keep them informed of the status of the request

• Contributes towards improvement of department scores for employee engagement, i.e. peer-to-peer accountability.

SERVICE ESSENTIAL FUNCTIONS

• Assists the department in distributing required notices, including the Medicare Notice of Discharge to patients, securing signatures on the form from the patient or their legal representative, and answering questions regarding the appeal process

• Distributes the Medicare Notice of Discharges to identified patients, including capturing patient and their legal representative's signatures, answering any questions regarding the appeal process

• Coordinates with the clinical staff to prioritize placement requests. Provides necessary documentation to facilitate post-acute services

• Assists with clerical and clinical functions for patients, physicians, and staff. Provides administrative support as needed, including scheduling follow-up appointments, and confirming the provision or delivery or post-acute services or equipment

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Participates in quality improvement initiatives and collects data for use in department performance improvement as directed. Maintains timelines for follow up and prioritization of department projects and tasks

• Updates and maintains resources, informat