Education: Bachelors degree in health care administration, business administration, or a related service management area preferred

Licenses/Certifications:  (None)

Experience / Knowledge / Skills:

• With a degree, minimum of 10 years physician practice management experience

• If without a degree, equivalent experience in physician practice management is required 15 years practice management experience and five (5) years of health care consulting and leading process improvement project teams

• Must have proven organizational skills with an ability to prioritize effectively, present information publicly, and communicate in writing clearly, concisely, thoroughly, and accurately

• Must have effective computer and communication skills; detailed-oriented, creative, and able to interface with other external and internal departments

• Must have extensive research capability to assure compliance with all federal and state regulations

• Normal office environment with frequent travel and occasional evening and weekend work hours

• Requires prolonged sitting, frequent standing, bending, stooping and occasional lifting up to 50 pounds

• Requires normal range of hearing and manual dexterity sufficient to operate keyboard, telephone, calculator and other office equipment as needed

Principal Accountabilities

Advises executive and senior leadership regarding matters related to MHMG business operations

• Workflow improvements

• Cost reduction opportunities

• Revenue opportunities

• Network management policy decisions

Provides internal consulting to the operations of new lines of business within MHMG

• Provider Solutions

• Consumer Solutions

• Employer Solutions

• Academic Solutions 

Leads the development and service offering of the Advanced Practice Management Services to aligned independent providers to include

• Comprehensive practice assessments

• Revenue cycle management

• Practice management:  staff education and training, policy and procedure development, other services. 

Supervisory Responsibilities

• Manages assigned staff within the (Physician Practice Management Consultant) PPMC Team. 

• Assists in advising MHMG Regional Directors and Practice Managers.

• Management, training and education of independent practice managers and staff as assigned through consulting agreements.

• Leads the coordination of the onboarding of acquired practices, new clinic developments, and new providers joining existing practices into MHMG.  And ensures new managers, providers, and associates understand MHMG goals, objectives and operations for a seamless transition. 

• Provides internal operational practice management start-up support for new clinics.

• Provides provider E&M compliance audit training for new MHMG providers and quarterly incident-to audits for behavioral health and surgical providers.

• Participates in recommending content for monthly Practice Manager Meetings.

• Organizes and facilitates week long quarterly Practice Management Orientations.

• Leads the enhancement of the efficiency and effectiveness of network provider enrollment and credentialing.

• Serves as a liaison to other associates and departments in the development and review of policies, procedures, forms, exit reports, training/pilot summaries, operational reviews and other reports generated by the PPM team. 

• Monitor the progress of projects, advice on outstanding issues, and preparing reports for COO and CEO.

• Works with Memorial Hermann Physician Organization’s Project Management Office (PMO) to secure PMO staff when and where needed to ensure that projects are completed within established time frames and budgetary parameters.

• Oversee activities to ensure compliance with applicable government regulations.

• Demonstrates respect for customer needs by developing and maintaining an active willingness to demonstrate value-based leadership and to participate as a team member.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Follows the Memorial Hermann guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).

• Maintains strict confidentiality.

• Maintains established Memorial Hermann and MHMG policies, procedures, objectives, quality assurance, safety, environmental and infection control.

• Performs other related work as required.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.

Education:  Bachelor's Degree preferred or 10 years of revenue cycle experience in a healthcare setting

Licenses/Certifications: Membership and/or participation with a Revenue Cycle Association (i.e., HFMA, AHIMA, NAHAM, etc.) preferred.

Experience / Knowledge / Skills:

• Bachelor’s degree requires five (5) to seven (7) years of hospital/healthcare business office or financial management experience with a minimum of three (3) years of formal or informal leadership experience. No degree requires a minimum of ten (10) years of hospital/healthcare business office or financial management experience with a minimum of three (3) years of formal or informal leadership experience.

• Experience in one of the revenue cycle functions, including but not limited to: Patient Access Management, Denial Management, Insurance Collections, Patient Remittance Posting, Claim Submission, Contract Management, or Appeals.

• Experience and working knowledge of health system administrative and clinical applications.

• Experience leading teams and managing multiple entry-level and experienced employees.

• Knowledge of payer contract agreements, billing practices, rules, and regulations for Medicare, Medicaid, Veterans Administration, and other state funded plans such as HHSC, Crime Victims, DARS, etc.) and all relevant state and federal laws regarding medical billing, including HIPAA privacy and security regulations.

• Knowledge of Medicare DDE, CWF, and TMHP on line system functionality.

• Knowledge of National Correct Coding Initiatives (NCCI), Medically Unlikely Edits (MUE), Medicare Secondary Payer (MSP), National Clinical Trial/Research, and other government applied claim edits and billing practice rules.

• Understanding of process management, system implementations and system maintenance.

• Strong interpersonal, customer-oriented skills. Must have proven organizational skills with an ability to effectively prioritize present information publicly, and communicate in writing clearly, concisely, thoroughly, and accurately.

• Must have experience in working with computer software, and be able to demonstrate strong analytical and problem solving skills, decision making skills, stress management skills and time management skills.

Principle Accountabilities:

• Responsible for oversight and management of government payer billing for multiple acute, post-acute, and outpatient locations including 17 acute care facilities and 163 ambulatory locations.

• Service lines include, inpatient and outpatient, emergency services, life flight, trauma, transplant, outpatient imaging, laboratory, inpatient/outpatient rehab, skilled nursing, and chemical dependency.

• Management of approximately two billion claims per year.  

• Direct supervision of a team of 15-20 staff members, including all human resource related activities such as hiring and performance management. Ability to create performance measures, goals, and produce sustainable outcomes.

• Evaluates the performance level of the unit and individuals. Defines performance expectations, measurement tools and policy and processes. Assist in the development of training programs/initiatives to enhance skills, knowledge and productivity of existing employees.

• Develops, implements and improves billing strategies and work plans that optimize billing performance and minimize billing expense.

• Serves as a liaison with facilities to identify reasons for billing issues, identifies and creates a positive plan of action to resolve accounts and mitigate avoidable claim edits.

• Uses analytical approach to problem solving using quantified data and measurable results to reach sound conclusions.

• Works collaboratively with all departments to ensure operational functions are aligned with strategic goals. Identify key stake holders of the organization.

• Builds trust and partnership amongst the team by enhancing engagement, addressing performance results and providing coaching and mentoring.

• Attends meetings with both contracted, non-contracted payers, and TMHP representatives to identify and resolve billing issues/discrepancies resulting in claim rejections or denials.

• Maintains current knowledge of CMS and TMHP billing requirements and establishes plans of action to address process or technology updates needed to ensure compliance with billing practices.

• Manage effective business unit meeting with clear objectives that align to business unit, department, and overall revenue cycle operational and financial goals.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.

Education: (None)

Licenses/Certifications:  CPR certification or ability to obtain within 90 days

Experience / Knowledge / Skills:

• Ability to communicate well with others.

Principal  Accountabilities

• Interacts with patient family members and staff to ensure patient safety and to expedite the timely arrival and departure of patients.

• Transports discharged and transferred patients along with belongings to designated areas.

• Transports patients in a timely manner to and from clinics and departments for medical tests along with any required patient equipment and medical chart.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.

Physical Demands

https://jobs.memorialhermann.org/patient-transporter-physical-demands 

Education: High School diploma or GED preferred

Licenses/Certifications: (None)

Experience / Knowledge / Skills:

• Prior experience in a business office or customer service setting

• Proficient typing/keyboarding skills

Principal Accountabilities

• Obtains demographic, insurance and financial information from patient or guarantor. Enters information in computer system in an accurate manner.

• Explains all required forms to the patient or guarantor and obtains the necessary signatures.

• Ensures medical necessity compliance by obtaining necessary data, reviewing Compliance System, communicating information to patient or guarantor and obtaining necessary signatures.

• Protects the financial integrity of the facility by collecting patient liability, establishing payment arrangements, discussing payment options and screening for eligibility.

• Verifies insurance eligibility and benefits and ensures all notifications and authorizations are completed within the required timeframes.

• Posts payments in the computer system and generates the appropriate patient receipts.

• Communicates in an effective and professional manner with Physicians, ancillary departments, nursing units, physicians’ office staff, insurance companies, as well as patients and their families (all Patient Access customers). Completes thorough and accurate documentation.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.

Education: (None)

Licenses/Certifications: Certified in Basic Life Support issued by (AHA) American Heart Association within 90 days of employment.

Experience / Knowledge / Skills:

• One (1) year of prior patient care experience (e.g. Certified Nursing Assistant, or Emergency Medical Technician, or Patient Care Technician) or similar role required, preferably in an acute care setting.

• Proficiency in all Core Competencies of the PCT I and II position as noted in Memorial Hermann’s PCT Competency Based Tool and as validated by Memorial Hermann Clinical Education no later than the end of orientation.

PRINCIPAL ACCOUNTABILITIES

• Provides direct patient care for assigned patients under the direct supervision of a licensed nurse.

• Direct patient care duties include but are not limited to vital signs (pre and post treatment, as applicable), visual monitoring of a patient’s condition, hygiene support, toileting support, mobility support, nutrition support, bathing support, charting, and other activities of daily living as needed.

• Responsible for timely and accurate documentation of information. Should appropriately report any unusual changes or findings to the nurse. 

• Assists in the maintenance of a safe and clean working environment.

• Demonstrates safe work practices and attitudes; follows safety rules; works to prevent unsafe conditions and behaviors; participates in organizational departments’ safety programs; adheres to all Memorial Hermann policies and procedures.

• Obtains and prepares laboratory specimens as prescribed within the scope of the role.

• Helps orient new employees as appropriate.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce.

• Other duties as assigned.

Education: (None)

Licenses/Certifications: (None)

Experience / Knowledge / Skills:

• Knowledge of anatomy and medical terminology required; ICD -10 and (AIS) coding experience preferred; relevant healthcare or coding work will also be considered

• Basic knowledge in the use of computer applications including Microsoft Office suite (Outlook, Excel, Word and PowerPoint)

Principal Accountabilities

• Analyzes and reviews patient medical records, abstracts data from data source; codes and enters data into trauma registry ensuring accuracy of data; maintains quality control of registry program.

• Assists with collection of registry data for performance improvement and registry projects.

• Ensures timely abstraction of data and adheres to deadlines as set forth by the Trauma Service Line

• Attends educational opportunities to enhance skill set as assigned.

• Adheres to all Memorial Hermann policies, procedures, & standards, within budgetary specifications, including time management, supply management, productivity, & accuracy of practice.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.

Education: Associate’s degree in Healthcare Administration, Finance, Business, Nursing, or related field, or In lieu of Associate’s degree, two (2) additional years of experience is required, for a total of seven (7) years of progressive experience in Revenue Cycle required.

Licenses/Certifications:

One of the following is preferred:

• Certified Professional Coder (CPC), or

• Certified Coding Specialist (CCS), or

• Certified Professional Biller (CPB)

• Certified Revenue Cycle Representative (CRCR), or

• Certified Healthcare Revenue Integrity (CHRI), or

• Project Management Professional (PMP), or

• Certified Lean Six Sigma

Experience / Knowledge / Skills:

• Five (5) years of progressive experience in Revenue Cycle required; experience in a consulting, analytics, or hospital system environment preferred. In lieu of Associate’s degree, two (2) additional years of experience is required, for a total of seven (7) years of progressive experience in Revenue Cycle required.

• Extensive knowledge of CPT/HCPCS/ICD-10, CMS process rules, payer reimbursement strategies, and workflow and process methodologies (DRG, APC, OPPS).

• Proficient in Epic (one or more Epic modules, especially Epic workflow and WQs), Microsoft Excel (pivot tables, formulas), and reporting tools (i.e. Tableau, Power BI, or SQL).

• Strong written and verbal communication and experience presenting to executive audiences.

• Proven success driving multi-stakeholder initiatives and optimizing revenue capture processes.

• Ability to lead complex assessments, manage projects, and influence cross-functional teams.

Principal Accountabilities

• Charge Capture Responsibilities:

  • Evaluates workflows and system configuration for missing, late, or duplicate workflow and processes.

  • Performs root cause analysis on workflow and process discrepancies and coordinates workflow and process reconciliation.

  • Recommends and implements workflow and documentation improvements to prevent leakage.

• Process Architecture & Pricing Responsibilities:

  • Collaborates with pricing and process architecture teams on annual price reviews, updates, and payer impact modeling.

  • Consults on workflow and process code additions, deletions, and revisions based on service line expansion or reimbursement updates.

  • Supports pricing strategies that maintain operational compliance and competitiveness.

• Data Analysis & Reporting Responsibilities:

  • Collaborates and uses data reporting resources to develop reports, dashboards, and variance analyses using Epic.

  • Interprets trends in revenue capture, claim process breakdowns or gaps, denial overturns, workflow and process lag, and payer mix shifts.

  • Provides actionable recommendations with measurable outcomes to clinical and finance stakeholders.

• Coding & Billing Compliance Responsibilities:

  • Identifies improper coding/documentation contributing to revenue variances.

  • Collaborates with coding, HIM, and operational compliance departments to ensure workflow and process and code integrity.

  • Assists with payer denial resolution strategy and monitors audit outcomes (internal and external).

• Project Management & Consulting Responsibilities:

  • Leads consulting engagements with operational and clinical teams on new initiatives (e.g., service expansion, provider onboarding, payer policy updates).

  • Provides subject matter expertise during system implementations and upgrades, including Epic optimization.

  • Tracks milestones, defines KPIs, mitigates risks, and ensures post-implementation sustainability.

• Collaboration & Training Responsibilities:

  • Provides training to department stakeholders on workflow and process policies, documentation expectations, Epic functionality, and revenue integrity standards.

  • Acts as a liaison between IT, Coding, Compliance, and Operational leaders to ensure aligned goals and effective communication.

  • Educates on current process and charging regulations, including No Surprises Act (NSA), GFE, and regulatory updates.

  • Supports continuous improvement projects across workflow and process review, process breakdowns or gaps management, and reimbursement accuracy.

• Additional Accountabilities:

  • Supports continuous improvement projects across workflow and process review, process breakdowns or gaps management, and reimbursement accuracy.

  • Conducts operational compliance reviews and audits trails to ensure defensible process practices.

  • Escalates high-risk revenue impacts with detailed analysis and mitigation strategies.

  • Represents Business Performance Optimization team on governance committees and operational workgroups.

  • Promotes a culture of transparency, accountability, and ethical process practices.

  • Complies with HIPAA and all regulatory, accreditation, and organizational policies.

  • Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

  • Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as a resource to less experienced staff.

  • Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce.

  • Other duties as assigned.

Education: Graduate of an accredited school of professional nursing required; Bachelors of Nursing preferred, or graduate of an accredited Master of Social Work program

Licenses/Certifications:

• Current and valid license to practice as a Registered Nurse in the state of Texas or

• Current and valid license as a Master Social Worker (LMSW) in the state of Texas required, LCSW preferred

• Certification in Case Management required within two (2) years of hire into the Case Manager position

Experience / Knowledge / Skills:

• Three (3) years of nursing or social work experience acute hospital-based preferred, or three (3) years of experience comparable clinical setting (i.e. ambulatory surgery center, infusion/dialysis clinic, Federally Qualified Health Clinic (FQHC), skilled nursing facility, or wound clinic)

• Experience in utilization management, case management, discharge planning or other cost/quality management program preferred

• Excellent interpersonal communication and negotiation skills

• Demonstrated leadership skills

• Strong analytical, data management and PC skills

• Current working knowledge of discharge planning, utilization management, case management, performance improvement, disease or population management and managed care reimbursement

• Understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre and post acute care. Demonstrated understanding of motivational interviewing and change management

• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components

• Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families

• Effective oral and written communication skills

Principal Accountabilities

• Coordinates/facilitates patient care progression throughout the continuum.

• Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient care.

• Addresses/resolves system problems impeding diagnostic or treatment progress. 

• Proactively identifies and resolves delays and obstacles to discharge.

• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.

• Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues. 

• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load. Monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.

• Facilitates the following on a timely basis: Completes and reports diagnostic testing, Completes treatment plan and discharge plan, Modifies plan of care as necessary, to meet the ongoing needs of the patient, Communicates to third party payors and other relevant information to the care team.

• Assigns appropriate levels of care.

• Completes all required documentation in TQ screens and patient records

• Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.

• Completes Utilization Management and Quality Screening for assigned patients.

• Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Department standards.

• Identifies at-risk populations using approved screening tool and follows established reporting procedures. Monitors LOS and ancillary resource use on an ongoing basis. 

• Takes actions to achieve continuous improvement in both areas.

• Refers cases and issues to Care Management Medical Director in compliance with Department procedures and follows up as indicated.

• Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients. 

• Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.

• Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.

• Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.

• Manages all aspects of discharge planning for assigned patients.

• Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician.

• Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation.

• Ensures/maintains plan consensus from patient/family, physician and payor.

• Refers appropriate cases for social work intervention based on Department criteria.

• Collaborates/communicates with external case managers.

• Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment and supplies.

• Documents relevant discharge planning information in the medical record according to Department standards.

• Facilitates transfer to other facilities as appropriate.

• Actively participates in clinical performance improvement activities.

• Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.

• Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data.

• Collects, analyzes and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team. 

• Uses concurrent variance data to drive practice changes and positively impact outcomes.

• Collects delay and other data for specific performance and/or outcome indicators as determined by Director of Outcomes Management. Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning).

• Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.

• Leads the development, implementation, evaluation and revision of clinical pathways and other Case management tools as a member of the clinical resource/team.

• Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators (e.g., readmission rates, unplanned return to OR, etc.)

• Acts as preceptor/mentor to new hires. 

• Assists in development of orientation schedule and helps identify individual needs for learning.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.

Education: Graduate of an accredited school of professional nursing required; Bachelors of Nursing preferred, or graduate of an accredited Master of Social Work program

Licenses/Certifications:

• Current and valid license to practice as a Registered Nurse in the state of Texas or

• Current and valid license as a Master Social Worker (LMSW) in the state of Texas required, LCSW preferred

• Certification in Case Management required within two (2) years of hire into the Case Manager position

Experience / Knowledge / Skills:

• Three (3) years of nursing or social work experience acute hospital-based preferred, or three (3) years of experience comparable clinical setting (i.e. ambulatory surgery center, infusion/dialysis clinic, Federally Qualified Health Clinic (FQHC), skilled nursing facility, or wound clinic)

• Experience in utilization management, case management, discharge planning or other cost/quality management program preferred

• Excellent interpersonal communication and negotiation skills

• Demonstrated leadership skills

• Strong analytical, data management and PC skills

• Current working knowledge of discharge planning, utilization management, case management, performance improvement, disease or population management and managed care reimbursement

• Understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre and post acute care. Demonstrated understanding of motivational interviewing and change management

• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components

• Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families

• Effective oral and written communication skills

Principal Accountabilities

• Coordinates/facilitates patient care progression throughout the continuum.

• Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient care.

• Addresses/resolves system problems impeding diagnostic or treatment progress. 

• Proactively identifies and resolves delays and obstacles to discharge.

• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.

• Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues. 

• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load. Monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.

• Facilitates the following on a timely basis: Completes and reports diagnostic testing, Completes treatment plan and discharge plan, Modifies plan of care as necessary, to meet the ongoing needs of the patient, Communicates to third party payors and other relevant information to the care team.

• Assigns appropriate levels of care.

• Completes all required documentation in TQ screens and patient records

• Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.

• Completes Utilization Management and Quality Screening for assigned patients.

• Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Department standards.

• Identifies at-risk populations using approved screening tool and follows established reporting procedures. Monitors LOS and ancillary resource use on an ongoing basis. 

• Takes actions to achieve continuous improvement in both areas.

• Refers cases and issues to Care Management Medical Director in compliance with Department procedures and follows up as indicated.

• Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients. 

• Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed.

• Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department.

• Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care.

• Manages all aspects of discharge planning for assigned patients.

• Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician.

• Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation.

• Ensures/maintains plan consensus from patient/family, physician and payor.

• Refers appropriate cases for social work intervention based on Department criteria.

• Collaborates/communicates with external case managers.

• Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment and supplies.

• Documents relevant discharge planning information in the medical record according to Department standards.

• Facilitates transfer to other facilities as appropriate.

• Actively participates in clinical performance improvement activities.

• Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.

• Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data.

• Collects, analyzes and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team. 

• Uses concurrent variance data to drive practice changes and positively impact outcomes.

• Collects delay and other data for specific performance and/or outcome indicators as determined by Director of Outcomes Management. Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning).

• Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.

• Leads the development, implementation, evaluation and revision of clinical pathways and other Case management tools as a member of the clinical resource/team.

• Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators (e.g., readmission rates, unplanned return to OR, etc.)

• Acts as preceptor/mentor to new hires. 

• Assists in development of orientation schedule and helps identify individual needs for learning.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.

Education:  Graduate of an accredited School of Professional Nursing; Bachelor of Nursing preferred

Licenses/Certifications:

• Current State of Texas license or temporary/compact license to practice professional nursing

• Certified in Basic Life Support

• Additional certifications may be required based on discipline and/or nursing unit requirements

Experience / Knowledge / Skills:

• RN I <1 year

• RN II = 1-3 years

• RN III = 3-10 years

• RN IV = 10+ years

Principal Accountabilities

• Delivers safe and appropriate care to patients, according to the nursing skills inventory and the age and needs of the patient/population served.

• Coordinates the planning for the delivery of nursing care with an interdisciplinary team and administers appropriate clinical decisions in the delivery of patient care.

• Collaborates with, directs, and may delegate to the healthcare team in the attainment of positive outcomes based on data, research, evidence, and professional standards of care. Coordinates treatment plans; develops/implements discharge and/or transfer plans.

• Participates in a systemic, interdisciplinary, and ongoing evaluation of programs, process improvement and desired client-centered outcomes.

• Considers the diverse needs of each patient through the entire continuum of care, providing and ensuring the highest level of service according to established service standards, optimizing the patient experience.

• Adheres to all regulatory and Texas Board of Nursing standards.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; may serve as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.

Minimum Qualifications

Education: 

• Bachelor of Science in Nursing degree from an accredited school of professional nursing required or documented degree plan and timeframe to complete Bachelor of Science in Nursing (BSN)

• For clinical manager positions in Magnet-designated hospitals or hospitals in pursuit of Magnet designation, a minimum of a BSN is required at the time of hire or promotion

Licenses/Certifications:

• Current State of Texas license or temporary/compact license to practice professional nursing

• Certified in Basic Life Support

• Professional certification in clinical area or management preferred

• Additional certifications may be required based on discipline and/or nursing unit requirements

Experience / Knowledge / Skills:

• Three (3) or more years experience in clinical area of practice; and

• Minimum of one (1) year experience in a supervisory or management role

• Clinical Manager II:  additional two (2) years experience (3 years total) in supervisory or management job

Principal Accountabilities

• Manages the daily operations of a patient care department, including forecasting and ensuring adequate staffing, taking departmental calls, planning for continuity of care, serving in charge nurse role and providing direct patient care as needed.

• Collaborates with physicians, management team members, business partners, and customers to address strategic initiatives and organizational goals.

• Participates in a systemic, interdisciplinary, and ongoing evaluation of programs, process improvement, desired client-centered outcomes, and organizational outcomes.

• Considers the diverse needs of each patient through the entire continuum of care, provides and ensures the highest level of service according to established service standards and optimizes the patient experience.

• Ensures adequate scheduling and staffing, recruits, retains, and develops staff, provides performance feedback, addresses issues as necessary, and provides input into staff performance reviews in a timely effective manner.

• Adheres to all regulatory and Texas Board of Nursing standards.

• Ensures safe care to patients, staffs and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; may serve as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann service standards of providing safe, caring, personalized and efficient experiences to patients and our workforce.

• Other duties as assigned.