Texas Health Resources RN Case Manager / Heart Hospital Outcomes Management / PRN in Arlington, Texas
RN Case Manager / PRN / Outcomes Management / Heart & Vascular Hospital at THAM
At Texas Health, a non-profit hospital system, our people make this a great place to work every day. Our inclusive, supportive, people-first, excellence-driven culture make Texas Health a great place to work.
2022 FORTUNE Magazine’s “100 Best Companies to Work For®” (8th year in a row)
Becker's Healthcare "150 Great Places to Work in Healthcare" (4 years running)
“America’s Best Employers for Diversity” list by Forbes
A “100 Best Workplaces for Millennials" by Fortune and Great Place to Work®
We’re looking for qualified Part Time RN Case Manager like you to join our Texas Health family.
Work location: Heart & Vascular Hospital at Texas Health Arlington Memorial, 811 Wright St, Arlington, TX 76012
Work environment: Outcomes Management
Work hours: PRN
Texas Health Arlington Memorial Hospital, a 369-bed acute-care, full-service medical center has been serving Arlington and the surrounding communities since 1958. Hospital services include comprehensive cardiac care, women’s services, neurosciences, cancer services, orthopedics, emergency services and an advanced imaging center. Texas Health Arlington Memorial has over 1,600 employees, 250 volunteers and 630 physicians on its medical staff. We invite you to join us in furthering your career and our accomplishments and philosophy of excellence. For more information, visit TexasHealth.org/Arlington.
As part of the Texas Health family, we employ over 24,000 employees and are among the areas top five largest employers. Come be a part of our exceptional team as we continue to provide outstanding care and deliver award winning results. You belong here.
Are you looking for a rewarding career with family-friendly hours and top-notch benefits?
Balance for Whole Health Medical and Wellness plan
Dental, Vision, HSA, Flex Spending Accounts
Paid Time Off: Use your PTO your way! Donate, Convert or Sell
Retirement Plan: Create the Retirement YOU Want!
Ask me, there’s more! Tuition reimbursement, student loan repayment, adoption assistance, employee relief fund, and supplemental benefits . . .
Associates Degree in Nursing (ADN) is required.
Bachelor of Science in Nursing (BSN) is preferred.
Three (3) years of RN experience in an acute care setting, case management or utilization review is required.
Must hold an active TX RN license - Registered Nurse upon hire is required.
BCCMN - Board Certified Nursing Case Management CPUR, CPHQ, CCS, PCUM upon hire is preferred (not required).
Individuals in this role will demonstrate: Excellent verbal and written communication, customer service, and basic computer skills. You will demonstrate good negotiation and collaboration and the ability to prioritize and meet deadlines.
You will conduct patient assessment and care coordination, identify at-risk populations, patients at risk for re-admission. Identify patients who have readmitted or are at high risk for readmission within 30 days with emphasis on HF, COPD, AMI and Pneumonia patients.
Obtains social, physical, psychological and financial histories from available resources. Assesses patient information utilizing medical knowledge. Identifies reasons contributing to patient readmissions.
Utilizes various methods for assessing an individual's psychological condition as well as their physical characteristics and/or manifestation of illness. Follows established reporting procedures.
Participates in development of individualized discharge plans to meet patient needs and referral source requirements. Establishes and supports realistic treatment/discharge goals with patients, families, and staff. Applies nursing/clinical knowledge skills and problem solving techniques to the case management process.
Meets directly with patient and family members when indicated based on identified needs and develops a continuing care plan in collaboration with patient family, physician and payor.
Coordinates care with unit case manager and interdisciplinary team. Documents the provision of case management services. Assist in reviewing and arranging appropriate resources as needed.
Assists in the identification of post-acute healthcare facilities (SNF, home health...) that provide high quality of care or specialized programs to more effectively meet patient needs. Facilitates placement of patients into the most appropriate facility/agency to meet the patient's specific needs. 35%
Discharge Planning Collaboration:
Manages aspects of discharge planning that require outside services for identified high-risk populations. Maintains active communication with patient, family members, physicians, nursing and other multi-disciplinary team members to develop treatment/discharge plans. Coordinates specific focused discharge interventions and services. Supports continuity of care for patients.
Demonstrates clinical decision-making in prioritizing and triaging referral requests. Clinically urgent cases are responded to within 24 hours of referral.
Refers appropriate cases for social work intervention based upon discharge needs. Make referrals to outside sources for disease management. Provide patient/family education to assist with self management.
Educate high-risk patients/family members on disease process, community resources. Coordinate post-discharge access to Parkland Hospital and JPS when indicated.
Partners with community providers to ensure continuity of care plan. Assists in obtaining PCP or specialist physician follow-up.
Obtain follow-up PCP appointment prior to discharge when appropriate. Obtain follow-up clinic appointment prior to discharge when indicated.
Makes post-discharge follow-up calls to identified high-risk populations to ensure patients receive the necessary services, and identify and remove barriers to clinical stabilization and continuity of care to prevent readmission. 35%
Performs utilization review according to Milliman criteria to determine the appropriate utilization of resources and patient classification.
Seeks consultation from appropriate disciplines/departments as required to assess care, monitor length of stay and facilitate discharge.
Identifies and resolves process problems impeding diagnostic or treatment progress. Solves discharge delays and seeks resolution of issues/obstacles by utilizing conflict resolution skills. Follows the appropriate chain of command and refers cases that do not meet criteria and/or that may be denied by third-party payors to the attending physician.
Provides patient and family members with information concerning third-party payor coverage and patient financial responsibilities for non-covered services. Acts as a consultant and assists physicians, care providers and other hospital personnel in understanding payor plans, resolving utilization management issues and assigning appropriate patient classification as required.
Utilizes Milliman Care Guidelines to determine medical necessity of admission and continued stay. Documents finding based upon criteria. Demonstrates knowledge of requirements for prior approval by payor for admissions, continued stay and transfers to alternative levels of care.6. Reviews patient records as requested by outside agencies for appropriate utilization of care/services.
Initiates meetings to review patients meeting high dollar and/or difficult placement criteria. 5%
Continuous Improvement/Outcome Management:
Seeks opportunities for improvement in quality of care/services. Reports pertinent quality/risk issues to appropriate individuals, department and/or committees in a timely manner. Participates on performance improvement teams as appropriate.
Monitors and documents activities ongoing to substantiate the effectiveness of performance improvement activities in order to achieve compliance with external agencies.
Collaborates with multi-disciplinary teams to facilitate appropriate assignment of community resources or interventions. Documents variances in the tracking system.
Maintains database on readmission trends, readmissions from post-discharge facilities/agencies, high-risk patients being followed by Community Case Manager.
Works with medical staff to develop disease specific care plans for high risk populations that frequently utilize the ED
Maintains a current knowledge of regulatory requirements for utilization management including but not limited to Joint Commission, TMF, TDI, Medicare, and Milliman Care Guidelines.
Applies knowledge of Medicare and Medicaid regulations to utilization of hospital services and educates others as appropriate
Professional Growth Development
Researches current literature regarding quality and utilization in order to remain current with the changing healthcare environment.
Attends and participates in professional organizations and seminars as deemed appropriate by director and/or manager including but not limited to management growth.
Additional perks of being a THR Registered Nurse:
Gain a sense of accomplishment by contributing in a teamwork environment
Positively impact patients’ quality of life
Receive excellent mentorship, comprehensive training and dedicated clinical leadership resources
Enjoy opportunities for growth
Explore our Texas Health careers site for info like Benefits , Job Listings by Category , recent Awards we’ve won and more.
Employment opportunities are only reflective of wholly owned Texas Health Resources entities.
We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.