The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patientâ��s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy Education provided to physicians, patients, families and caregivers.
The individualâ��s responsibilities include the following activities:
Accurate medical necessity screening and submission for Physician Advisor review,
Transition planning assessment and reassessment,
Implementation or oversight of implementation of the transition plan,
Leading and facilitating multi-disciplinary patient care conferences,
Managing concurrent disputes,
Making appropriate referrals to other departments, h ) identifying and referring complex patients to Social Work Services,
Communicating with patients and families about the plan of care,
Collaborating with physicians, office staff and ancillary departments,
Leading and facilitating Complex Case Review,
Assuring patient education is completed to support post-acute needs ,
Timely complete and concise documentation in Case Management system, n ) maintenance of accurate patient demographic and insurance information,
Identification and documentation of potentially avoidable days,
Identification and reporting over and underutilization,
And other duties as assigned
Required: Graduate of an accredited school of nursing. Academic degree in nursing (bachelor's or master's). Preferred: Academic degree in nursing (bachelor's or master's).
Required: 2 years of acute hospital patient care experience. Preferred: Acute hospital case management experience.
Required: Active Registered Nurse license. Preferred: Accredited Case Manager (ACM)
Must complete Tenetâ��s InterQual education course within 30 days of hire (and at least annually thereafter) and pass with a score of 85 or better. Must complete and demonstrate competency in using the Tenet Case Management documentation system within 30 days of hire. Attendance at hospital and department orientation is required. Department orientation includes review and instruction regarding Tenet Case Management and Compliance policies, InterQual, Transition Management, Utilization Management, and other topics specific to case management
Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.