Case Manager (Compact RN license required) Job Listing at Emerus Holdings Inc. in Houston, TX (Job ID 2025-19841)

Description

The purpose of this position is to provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. The goal of the position is to enhance the quality of patient care through innovative and cost-effective best practices. This position promotes the integration of case management, utilization review, discharge planning, denial management and patient transfer management to ensure successful continuity care.

• Compact Registered Nurse (RN) license, required
• 2 years hospital clinical experience, required
• Bachelor's Degree, strongly preferred
• Utilization Review/Case Management experience, preferred
• Active Case Management Certification or other professional RN Certification, preferred
• InterQual and/or Milliman experience, preferred
• Superior interpersonal skills
• Ability to establish and maintain collaborative, effective working relationships
• Ability to communicate professionally and effectively in oral, written and electronic formats
• Demonstrate analytical and critical thinking abilities with proactive decision-making and negotiating skills
• Demonstrate professional organizational skills
• Ability to manage multiple tasks simultaneously
• Position requires fluency in English; written and oral communication

• Ensure patient progression through continuum of care
• Ensure compliance during all admission and transfer processes
• Document patient outcomes during and after each coordination of care
• Maintain patient health information privacy at all times
• Coordinate transfer center admission and/or transfer requests as required
• Coordinate and complete daily patient continuum reports as required
• Complete and ensure Utilization Review of all admissions
• Maintain regulatory compliance with CMS Conditions of Participation
• Record and report extended delays in care
• Coordinate discharge planning
• Monitor and update discharge planning resources
• Perform denial management responsibilities
• Coordinate payer communication
• Act as a patient advocate: investigate and report adverse occurrences and perform staff education related to resource utilization, discharge planning and all other pertinent aspects of healthcare delivery
• Collaborate with clinical staff in development and execution of the plan of care and achievement of goals
• Minimal travel may be required
• Perform other duties as assigned