Methodist Dallas Medical CenterDepartment:
* Bachelor's of Science
Job Purpose: In conjunction with and in support of the physician-led multidisciplinary care team, assures the appropriate use of clinical resources to accomplish the optimal clinical outcomes. The above is accomplished through the use of medical staff or organizational accepted criteria for determining appropriateness for admission, level of care, and discharge, coordination of patient care through coaching and mentoring care givers, case managing selected cases, and facilitating discharge/transition planning. Participates in ongoing clinical improvement, hospital, and medical staff quality initiatives.
Supports the mission, vision, values and strategic goals of Methodist Health System.
Bachelor of Science, Nursing preferred (waiver may be granted for ADN with equivalent experience, knowledge, and skills and Director approval).
Disciplines with similar education preparation, experience, knowledge, other than Nursing may be considered in order to match the needs of particular populations.
Licenses and/or Certifications
CCM in Case Management preferred.
License from respective agency for non-nurse professional
Licensed in Texas as a Registered Nurse
Related Work Experience and Other Skills
A high achiever who is flexible
Ability to prioritize multiple job tasks in a fast paced environment
Ability to work as a team player
Able to maintain and exhibit professionalism
Able to make independent and responsible decisions. Self-starter and demonstrates initiative
Acute hospital case management experience preferred
Assertive and thorough
Effective organizational and interpersonal skills including written and verbal communication skills
Evidence of leadership, creativity and self-improvement
Exhibits good judgment, strategic thinker, and cultural appropriateness. Ability to translate theory into practical application. Ability to think logically and strategically
Experience with Word, Excel, PowerPoint, and internet programs
High level of energy and motivation
Positive role model for staff and other health care professionals
Proficient with clinical issues for population served
Work Experience: 2 years or more of heath care experience – minimum 1 year acute hospital experience
•Assure the appropriate application of internal and external utilization review for hospital patients: Assesses medical necessity for admission, level of care, and discharge/transition; Interacts with payers to assure timely and accurate communication of patient status and plans; Advocates, as needed for patient and organization in case review with payers; Assists in the identification and assessment of feasible alternative options with payers for individual patients; Enters necessary data for tracking interventions wit payers, etc.
•Clinical Care: Functions in a “care giver” role for case managed patients; e.g. education, assessment, care planning; Maintains clinical knowledge for population served; 16 CEU hours/year related to clinical population served and/or Care Management.
•Coach and mentor staff on the use of Medical/Care Management components: Reviews patients progress with interdisciplinary team caring for patient; Helps the staff in establishing care plan, goals, and discharge plan/referrals/consults; Participates in unit team meetings related to discharge, clinical improvement, etc.; Provides clinical updates related to population served; Supports and participates in organizational clinical educational offerings; e.g. internships.
•Coordination of care including management/catastrophic case management, discharge planning: Develops plan of care for case managed patients; Monitors and tracks outcomes and resource use for case managed patients; Coordinates the timely review of clinical findings; Assists in the exchange of information between consultants, interdisciplinary team, patient/family; Coaches and mentors staff related to care coordination.
•Maintains current knowledge of federal, state, hospital and JCAHO guidelines relating to medical and utilization management and quality improvement.
•Participates in MHD’s Value Management, Service Management, and Recognition Programs and related activities.
•Provides clear mechanisms for interdisciplinary team communication/feedback: Participates in case review, grand rounds, discharge planning conference, team meetings related to patient care; Provides frequent update on Care Management key measures of success related to specific units or populations; Provides coaching/mentoring to staff related to Care Management; Establishes mechanism to receive regular feedback from units/departments about interface functioning. Acts upon identified areas for improvement.
•Provides necessary consumer education, triage, and then develops, with patient and physician, appropriate demand management options for case managed patients: Identifies pattern of health system use which is less than optimal for achieving desired outcomes (clinical and financial); Establishes mutually agreed upon plan with patient and physician using available patient, community, payer, or organizational resources.-
•Support the use and assists in the development of Clinical Improvement processes and tools: Is knowledgeable about the development, implementation, and use of clinical improvement tools; Participates on CI teams for the purpose of revising and/or developing CI tools.
•Supports Medical Staff QA through report generation, data submission, and analysis of data.