Case Manager III - State Hospital

Job Description

Case Manager III

The Case Manager III performs highly complex (senior level) case management work. Oversees case management activities for all persons at the RGSC Outpatient Clinic. Work involves developing and maintaining long-term contact with patients and families and service providers for medical, social, education plan of care. Develops a plan of care and relative service needs. Accountable for developing, facilitating services, and partnering with community resources to address the needs of the patients. Coordinates medical referrals, interpreter services, DARS, RGVIHCC/ Hidalgo County and Willacy County, Social Security Administration and other services through intra-agency or interagency service coordination and referral incidents. Responsible for ensuring that all patients are evaluated, assessed and referred for assistance through local community, county, state, and federal programs. Prepares and submits monthly, quarterly, and annual reports or performance improvement plans for quality assurance and utilization review processes for case management to ensure quality services.

The Case Manager III functions independently and seeks guidance from leadership as needed. The Case Manager III makes decisions regarding the patient's case with input from the patient, family members if appropriate, and community resources. Supervises the work of others as necessary. Works under limited supervision, with considerable latitude for the use of initiative and independent judgment.

Performs other duties as assigned. Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location.

Essential Job Functions

Attends work on a regular basis and may be required to work a specific shift schedule or, at times, even a rotating schedule, extended shift and/or overtime in accordance with agency leave policy and performs other duties as assigned.

Will perform Case Management Services and communicate effectively with Rio Grande State Center Outpatient Clinic patients and their families on a timely basis. Maintains confidentiality and ensures appropriate information is documented in the EMR using the Social Work template. Maintain a service log of all monthly referrals. Performs case management services and assignments for patients with special needs. Assists with monitoring the overall program and providing program evaluation.

Provides options for medical care services such as SSI Disability benefits, medical referrals, insurances, prior authorization, interpreter services, DARS, TDHSH Medicaid/ Snap/TANF, Child and Adult Protective Services, RGVIHCC/ Hidalgo and Willacy, Epilepsy Foundation, UTMB Dysplasia Clinic, Family Crisis Center, Mujeres Unidas, Salud y Vida, Housing Authority, and Breast Cervical Cancer Services, and other entities according to the patient’s individual needs. (15%)

Documents progression of case into the patient’s medical record. Prepares and submits monthly, quarterly and annual performance improvement plans and reports to Quality Management and associated departments. Works closely with other HHSC facilities to ensure continuity of care when patients are transferred between agencies. Works with physicians to ensure referrals are accurate and reflective of treatment orders.

Interacts with patients and or families, co-workers and stakeholders, in a friendly and professional manner while providing current and correct information to using appropriate resources. Provides timely customer service by demonstrating courtesy, tact, respect, a desire to help, initiate and sense of urgency in all contacts with patients and their families.

Functions as a team member in the daily operations of the Case Management Department and or in collaboration other departments. Promotes good public relations with the patient care units, hospital departments, and the community.

Works closely with other HHSC facilities to ensure continuity of care when patients are transferred between agencies.

Will oversee the referral of services for patients and prepares the quarterly indicator report on findings. Manages Clinic outpatient referrals and ensures patient is contacted within 72 hours to discuss referrals. An appointment with the specialist will be made and will receive reports from the specialist within 14 business days from appointment date.

Accountable to The Joint Commission (TJC) and Centers for Medicare and Medicaid Services (CMS) standards for accreditation and the required documentation authored by the case manager must meet TJC and CMS standards. Completes such documentation within 72 hours in order to maintain compliance with TJC and CMS standards.

Performs other duties as assigned. Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location.

Knowledge Skills Abilities

Knowledge of community resources and case management principles, objectives, standards, and methods.

Knowledge in using Electronic Medical Record.

Knowledge of applicable rules, regulations and policies.

Knowledge of related legislative and legal practices and procedures Ability to effectively communicate both orally and in writing with staff and the public in English and Spanish.

Skilled in Microsoft; Outlook, Word, Excel.

Skilled in handling difficult, emotional charged or sensitive situations.

Skilled in organizing and prioritizing workload and interacting with diverse individuals respectfully in a professional manner.

Ability to collect and analyze program data for quality and outcome monitoring.

Ability to assess client needs.

Ability to coordinate client services.

Ability to monitor program effectiveness.

Ability to maintain and promote confidentiality effectively within groups.

Ability to work on multiple projects and meet time sensitive deadlines.

Ability to work independently and productively with all levels of staff.

Ability to accurately and effectively maintain records, files, and reporting systems.

Ability to prepare correspondence, forms and requisitions.

Ability and willingness to work beyond scheduled hours to ensure deadlines are met.

Registration Or Licensure Requirements

Must possess valid Texas driver’s license or obtain it no later than 90 days after hire date. Applicants with an out-of-state driver’s license must provide an original certified driving record from the state of driving licensure. Eligible driving record required based on HHSC Fleet Management policy.

Initial Selection Criteria

Experience in case management or social services work.

Graduation from an accredited four-year college or university with major coursework in social work or a related field is generally preferred, experience and education may be substituted for one another, on a year for year basis.

At least (2) years of experience in patient case management.

Able to communicate in both English and Spanish - oral and written as indicated on the application

Additional Information

Applicants must pass a fingerprint criminal background check, pre-employment drug screen, and registry checks including the Client Abuse/Neglect Reporting System (CANRS), Nurse Aid, Medication Aide and Employee Misconduct, and HHS OIG list of Excluded Individuals/Entities.

Males between the ages of 18-25 must be registered with the Selective Service. All applicants must be at least 18 years of age to be considered for employment at a state-operated facility. Waco Center for Youth applicants must be 21 years of age. Flexibility in work hours may be required for this position. The position may be required to work overtime and/or extended hours.

Compliance with HHSC immunization policy and state hospital operating procedures related to immunizations is required. According to the Centers for Disease Control and Prevention, healthcare workers are at significant risk for acquiring or transmitting hepatitis B, measles, mumps, rubella, varicella (chicken pox), tetanus, diphtheria, pertussis (whooping cough), and influenza. All these diseases are vaccine preventable. Vaccines may be provided. As a result, state hospital policy requires employees be vaccinated according to their level of contact with individuals. In the event you choose to not be immunized for the influenza virus, you may be required to wear a mask and take other protective measures.

If you need assistance completing the online application, contact the HHS Employee Service Center at 1-888894-4747.

HHS agencies use E-Verify. You must bring your 1-9 documentation IvGth you on your first day of work. In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Requisition#619832

MOS Code

68X, HM, 0149, 4C0X1

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to: 68X, HM, 0149, 4C0X1. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information see the Texas State Auditor’s Military Crosswalk at http://www.hr.sao.state.tx.us/Compensation/JobDescriptions.aspx

HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.

I-9 Form - Click here to download the I-9 form.

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

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