Case Manager-Registered Nurse (RN)

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At Houston Methodist, the Case Manager (CM) position is a registered nurse (RN) responsible for comprehensively planning for case management, which includes care transitions and discharge planning of a targeted patient population on a designated unit(s) and/or service lines. This position works with the physicians and interprofessional health care team to facilitate and maintain compassionate, efficient, quality care and achievement of desired treatment outcomes. The CM position holds joint accountability with the social worker for discharge planning and continuity of care and assures that admission and continued stay are medically necessary, communicating clinical information to payors to ensure reimbursement.

FLSA STATUS
Exempt

QUALIFICATIONS

EDUCATION

Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section.
Bachelor’s degree preferred

EXPERIENCE

Three years hospital nursing clinical experience
Case management experience preferred

LICENSES AND CERTIFICATIONS
Required

RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)

SKILLS AND ABILITIES

Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
Knowledge of Medicare, Medicaid and Managed Care requirements
Progressive knowledge of community resources, health care financial and payor requirements/issues, and eligibility for state, local and federal programs
Progressive knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement
Understanding of pre-acute and post-acute venues of care and post-acute community resources
Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families
Well versed in computer skills of the entire Microsoft Office Suite (Excel, Outlook, PowerPoint and Word)
Strong assessment, organizational and problem-solving skill

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

Communicates in an active, positive and effective manner to all health care team members and reports pertinent patient care and family data in a comprehensive and unbiased manner; listens and responds to the ideas of others.
Collaborates with staff from the interprofessional health care team concerning safety data to improve outcomes and the safe transition of care. Uses a structured format for regular communication with patients and families.
Contributes towards improvement of department scores for employee engagement, i.e. peer-to-peer accountability.

SERVICE ESSENTIAL FUNCTIONS

Assesses all patients timely and thoroughly. Participates in daily Care Coordination Rounds (CCR), and identifies, communicates barriers to efficient patient throughput. Supports patients and families in preventing/resolving clinical or ethical issues.
Facilitates discharge planning activities for assigned patients and collaborates with the social worker and other members of the interprofessional health care team, as well as patient and family, on complex discharges. Maintains ownership of the discharge planning process on assigned units.
Initiates and facilitates referrals for home health care, hospice, and durable medical equipment. Consults with Social Worker Case Manager to assess psychosocial needs associated with transition to alternative levels of care, ensuring discharge disposition is to the appropriate level. Facilitates transfers.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

Modifies care based on continuous evaluation of the patient’s condition, demonstrates clinical problem-solving and critical thinking, and makes decisions using evidence-based analytical approach. Documents accurate assessment and interventions efficiently and effectively.
Plans for routine discharge and elevates emergent situations. Manages usual patient assignment and other unit demands and anticipates/plans for potential problems.
Focuses on discharge domain by contributing to department and hospital targets for quality, patient satisfaction and safety measures.

FINANCE ESSENTIAL FUNCTIONS

Performs review for medical necessity of admission, continued stay and resource use, appropriate level of care and program compliance using nationally recognized screening guidelines. Manages assigned patients in Observation Status, daily, informing physicians of timely disposition options to assure maximum benefits for patients and reimbursement for the hospital.
Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization, and continued stay.
Participates in denial mitigation activities to ensure appropriate reimbursement for services rendered.
Contributes to meeting department and hospital financial target, with focus on length of stay. Utilizes resources with cost effectiveness and value creation in mind. Self-motivated to independently manage time effectively and prioritize daily tasks, assisting coworkers as needed.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

Identifies areas for improvement based on understanding of evidence-based practice literature. Initiates evidence-based practice/performance improvement projects based on these observations and offers solutions by participating in unit projects and activities.
Seeks opportunities to identify self-development needs and takes appropriate action. Ensures own career discussions occur with appropriate management. Completes and updates the My Development Plan on an on-going basis.

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

Uniform: No
Scrubs: No
Business professional: Yes
Other (department approved): No

ON-CALL*

*Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.

On Call* Yes

TRAVEL**

**Travel specifications may vary by department**

May require travel within the Houston Metropolitan area Yes
May require travel outside Houston Metropolitan area No

QUALIFICATIONS

EDUCATION

Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section.
Bachelor’s degree preferred

EXPERIENCE

Three years hospital nursing clinical experience
Case management experience preferred

LICENSES AND CERTIFICATIONS
Required

RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)

Company Profile:

Houston Methodist Hospital is recognized by U.S. News & World Report as the No. 1 hospital in Texas and one of America’s “Best Hospitals.” As a full-service, acute-care hospital located in the Texas Medical Center and the flagship hospital of Houston Methodist, it has evolved into one of the nation’s largest nonprofit teaching hospitals and a leader in innovative medical research with a comprehensive residency program. Two of Houston Methodist’s primary academic affiliates are among the nation’s leading health care organizations: Weill Cornell Medicine and New York-Presbyterian Hospital. Houston Methodist also has affiliations with Texas A&M University and the University of Houston. Houston Methodist Hospital offers unparalleled care for thousands of patients from around the world.

Houston Methodist is an Equal Opportunity Employer.

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5 Questions You Should Ask During the Interview

Here are 5 questions we think you could ask during your interview. Use them as a guide to help you write your own questions.

Remember: Always have at least 5 questions prepared for the interview. If you do not, you run the risk of looking unprepared.

What does success look like in this role, and how is it measured?

Why ask this? You want to ensure you have a clear understanding of expectations before accepting the role. Knowing how success is measured helps you hit the ground running and avoid surprises about performance evaluations. It also signals to the employer that you're results-driven.

Can you describe the team dynamic and the company culture?

Why ask this? Skills and experience matter, but if the work environment isn’t a good fit, you won’t be happy or productive. This question helps you gauge whether the company values collaboration, how teams interact, and whether the culture aligns with your work style and values.

What are the biggest challenges facing the person in this role right now?

Why ask this? Every job has challenges, and it’s better to know them upfront. This helps you assess whether the role is a good fit for your strengths and whether the company is realistic about its expectations. If they hesitate to answer, it could be a red flag.

How does the company support work-life balance and employee well-being??

Why ask this? Burnout is real, and some companies expect employees to sacrifice personal time for the job. By asking this, you’ll get a sense of how they value work-life balance, flexibility, and well-being—things that are crucial for job satisfaction and long-term success.

These questions help you make an informed decision while also showing your professionalism and strategic thinking!

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