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At Memorial Hermann, we're about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care.
Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it.
Job Summary
This position will split locations. Primary location is PL and will also go to TMC.
The Transitional Care Manager (TCM) is responsible for providing transitional care management services within the risk based payment programs. The TCM will manage and support an assigned population with moderate to complex care needs throughout a 90-day episode of care with the purpose of improving health outcomes and resource utilization through a coordinated approach. The TCM works in collaboration and continuous partnership with patients and their family members, as well as clinic, hospital and post-acute partners, along with community resources, to achieve the desired outcomes. The TCM will use a defined process to identify patients/members that are in a bundled payment model, establish care plans and goals, and coordinate care and services throughout the continuum of care. The goal of the TCM is to enhance patient health and well-being, improve adherence to established care plans, and ensure appropriate utilization of resources.
The TCM must be highly collaborative with strong customer service skills and demonstrate the ability to actively engage patients in positive relationships. The TCM is knowledgeable and experienced applying the skills necessary to provide care management services appropriate to the patient/member being served. The TCM demonstrates knowledge of the principles of growth and development as it relates to the different life cycles. Specific age groups that are served by this position are circled.
Job Description
Minimum Qualifications
Education: Graduate of an accredited school of professional nursing required, BSN preferred or graduate of an accredited masters of social work program (MSW)
Licenses/Certifications: