Hospice RN Case Manager

The RN Case Manager is responsible for assessing, planning, coordinating, implementing, and evaluating nursing and multidisciplinary care for assigned patients to ensure optimal outcomes and appropriate utilization of resources. The role spans across the continuum of care: from acute inpatient hospital settings to post-acute care, discharge planning, transitions, and community or telephonic follow-up. (See similar responsibilities in local postings: e.g., utilization review and care transitions)

Key Responsibilities

• Perform comprehensive assessments of patients (clinical, psychosocial, functional, discharge needs) and determine baseline status and risk factors.
• Develop individualized care plans in collaboration with the multidisciplinary team (physicians, nursing, social work, rehab, case managers, payers, etc).
• Monitor patient progress, clinical status, and care plan implementation; adjust plan and intervene as needed.
• Facilitate safe, timely transitions/discharge from one level of care to another (e.g., from hospital to home, SNF, home health, outpatient). Reduce avoidable readmissions.
• Perform utilization management / review for appropriateness of care level, length of stay, medical necessity, authorizations, appeals, and payer communication.
• Coordinate care and resources (including durable medical equipment, home care services, outpatient follow-up, community referrals) to support optimal outcomes.
• Participate in interdisciplinary rounds and meetings, provide nursing expertise and act as liaison among team members, patients/families, and external stakeholders.
• Educate patients, families, caregivers and team members about disease management, self-care, discharge instructions, and community resources.
• Maintain accurate and timely documentation in the patient record, care plan, EMR, utilization reviews, regulatory reporting, KPI tracking, and quality improvement activities.
• Identify trends, analyze data (e.g., readmissions, adverse events, length of stay), and work on performance improvement initiatives.
• Comply with federal/state regulations (e.g., Medicare conditions of participation), facility policies, accreditation standards (e.g., The Joint Commission), and payor requirements.
• Depending on setting, may perform hands-on nursing care, mentor or coach less experienced staff, and participate in on-call coverage or extended shift work.

Qualifications

Education & Licensure:

• Current, unrestricted Registered Nurse (RN) license in Texas (or eligibility)
• Bachelor of Science in Nursing (BSN) preferred; Associate's acceptable in some settings. For example, some postings require BSN, others accept ADN.
• BLS (Basic Life Support) certification required
• Case Management certification (e.g., Commission for Case Manager Certification (CCM) or Certified Case Manager (CCM) or equivalent) preferred or willingness to obtain.

Experience & Skills:

• Strong knowledge of healthcare delivery, acute and post-acute care transitions, resource coordination, and reimbursement mechanisms.
• Excellent communication (oral & written), interpersonal, analytic, and decision-making skills.
• Proficiency with EMRs, data collection, Microsoft Office (Word, Excel, Outlook), web-based applications.
• Ability to work independently, manage multiple priorities, and adjust to changing patient care needs.
• Bilingual (English/Spanish) preferred in San Antonio market due to population demographics.

Performance Metrics / Success Indicators

Examples of metrics by which performance may be evaluated:

• Percentage of patients successfully transitioned to appropriate level of care without delays
• Readmission rate for monitored population
• Length of stay metrics and variance from expected
• Utilization review completion within required timeframes and appeals outcomes
• Documentation completeness and timeliness
• Patient/family satisfaction scores (where applicable)
• Participation in quality improvement initiatives
• Achievement of cost/utilization targets and compliance with payor requirements

Job Type: Full-time

Ability to Commute:

• Eagle Pass, TX Required)

Ability to Relocate:

• Eagle Pass, TX 78852: Relocate before starting work (Required)

Willingness to travel:

• 25% (Preferred)

Work Location: In person