Case Manager-Registered Nurse (RN)

Houston Methodist Hospital is a prestigious and highly respected healthcare institution, consistently ranked as the No. 1 hospital in Texas and one of America’s Best Hospitals by U.S. News & World Report. Situated in the renowned Texas Medical Center, Houston Methodist serves as the flagship hospital of the Houston Methodist system. It is recognized as one of the nation’s largest nonprofit teaching hospitals and a pioneer in innovative medical research with a comprehensive residency program. The hospital collaborates closely with top academic affiliates including Weill Cornell Medicine, New York-Presbyterian Hospital, Texas A&M University, and the University of Houston. Houston Methodist’s commitment to excellence extends to providing unparalleled care for thousands of patients both locally and globally. As an Equal Opportunity Employer, the hospital fosters a diverse and inclusive workplace where patient-centered care and clinical excellence remain at the forefront.

The Case Manager (CM) position at Houston Methodist is a specialized nursing role designed for a Registered Nurse (RN) who plays a crucial part in case management, care transitions, and discharge planning for a targeted patient population across specific units and/or service lines. This role involves close collaboration with physicians and a multidisciplinary healthcare team to ensure delivery of compassionate, efficient, and quality care, while achieving desired treatment outcomes. The CM holds joint accountability with social workers for discharge planning and ensuring the continuity of care. By verifying medical necessity for admissions and continued stays, the CM communicates pertinent clinical information to payors to secure appropriate reimbursement.

This position requires an individual who can operate independently with sound judgment and who possesses strong communication, clinical assessment, organizational, and problem-solving skills. The Case Manager actively participates in daily care coordination rounds, identifies potential barriers to patient throughput, and facilitates discharge planning activities, including referrals for home health care, hospice, and durable medical equipment. The position also entails managing patients' observation status to optimize both patient benefits and hospital reimbursement. Knowledge of Medicare, Medicaid, managed care requirements, and community resources is essential to navigate financial and social aspects of care.

In addition to clinical responsibilities, the CM contributes to department and hospital quality, safety, and patient satisfaction goals by employing evidence-based strategies and performance improvement initiatives. This role also involves participating in denial mitigation activities and working towards meeting financial targets with attention to length of stay and resource utilization. The Case Manager demonstrates proficiency with computer applications such as Microsoft Office Suite to support documentation and communication.

Work attire for the role is business professional, and the position requires availability for on-call status during emergencies and occasional travel within the Houston metropolitan area. Candidates typically hold a Bachelor’s degree preferred, with a minimum of three years of hospital nursing clinical experience; case management experience is desirable. Licensure as a Registered Nurse with Texas State Boards is required, with the expectation to obtain a permanent Texas license within 60 days if residency is established.

Overall, the Case Manager role at Houston Methodist is a key position that combines clinical nursing expertise with case management and care coordination to facilitate seamless patient care transitions, improve health outcomes, and support hospital operational and financial performance.