Summary

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 patient�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

Responsibilities

The individual�s responsibilities include the following activities:

• Accurate medical necessity screening and submission for Physician Advisor review,
• Care coordination,
• 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

Education

Preferred: Bachelor of Science in Nursing (BSN)

Experience

Required: Two (2) years acute hospital patient care experience.
Preferred: Acute hospital case management experience.

Certifications

Required: Active Registered Nurse license.
Preferred: Accredited Case Manager (ACM)