Job Description

The Case Manager will assume primary responsibility of cases for documentation of appropriate medical necessity for the inpatient or observation status. Communicates with physician, ancillary staff, and payers and assists in arranging transfers

or alternate placement when indicated. Assures proper level of care assignment. Facilitates with Case Managers and other allied health professionals to promote and ensure that quality care is provided and outcomes are achieved in a timely and cost-effective

manner. Utilizes a complete and systematic methodology/process to assess, plan, implement, evaluate and provide patient care coordination for patients from pre-hospital through post-hospital aftercare. Assists in the development of physician profiles to identify

over/under utilization patterns. Promotes appropriate post-hospital utilization of resources, adequate education of patient and hospital staff, and decreased incidence of re-admissions. Supports hospital goals and objectives in compliance with regulatory guidelines.

The Case Manager will work in collaboration with all healthcare disciplines to assure a continuum of appropriate and timely services. to assess the medical appropriateness, quality, and cost-effectiveness of proposed hospital, medical, and surgical services in

accordance with established criteria. Collaborates with the multidisciplinary team to assist patient with benefits resource management, evaluating appropriateness of the level of care, and communicating with the payer to obtain authorization. Identifies and plans

strategies to reduce inpatient length of stay and resource consumption.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

1. Graduate of an accredited school of nursing.

2. 3 years recent acute care nursing experience required. General medical /Surgical and/or Critical nursing preferred. Utilization and managed care experience desirable.

3. Licensed by the State of Texas as a registered Nurse(Case Manager Certification preferred.)

4. Education regarding Stroke Awareness must be completed within 6 months of hire.

Ability to work competently with computer based charting and other clinical and non-clinical software programs, Adaptability to

change, good organizational skills, read and communicate effectively in English, working knowledge of criteria and understand insurance

companies and coverage details. Working knowledge of Medicare, Medicaid and managed care utilization review requirements. Ability to

advocate for patient's., operate office equipment. Critical thinking skills. Effectively interact with insurance companies and communities

healthcare recourses. Utilizes independent judgment and discretion, in addition to consideration of standards outlined by Milliman and


Application Instructions

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