Carondelet Health Network
Overview
RN Case Manager Full Time Days. 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 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 role integrates national standards for case management scope of services including utilization management, transition management, care coordination, and compliance with regulatory requirements and Tenet policy. Education is provided to physicians, patients, families and caregivers. Responsibilities
Utilization Management: support medical necessity and denial prevention. Transition Management: promote appropriate length of stay, readmission prevention and patient satisfaction. Care Coordination: demonstrate throughput efficiency while ensuring the care is the right sequence and at the appropriate level of care. Compliance: adhere to state and federal regulatory requirements, TJC accreditation standards and Tenet policy. Education: provide education to physicians, patients, families and caregivers. Participate in accurate medical necessity screening and submission for Physician Advisor review. Coordinate care and plan transitions; assess and reassess transition planning. Oversee the implementation of transition plans and lead multidisciplinary patient care conferences. Manage concurrent disputes and make appropriate referrals to other departments. Identify and refer complex patients to Social Work Services; communicate the plan of care with patients and families. Collaborate with physicians, office staff and ancillary departments; lead Complex Case Reviews. Ensure patient education supports post-acute needs and complete documentation in the Case Management system. Maintain accurate patient demographic and insurance information; identify potentially avoidable days and report over/underutilization. Perform other duties as assigned. Qualifications
Licensure/Certification/Registration Required: RN. Must be currently licensed, certified or registered to practice as required by law or regulation in state of practice. Active RN license for state(s) covered. Preferred: Accredited Case Manager (ACM). Education Required: Graduate of an accredited school of nursing. Preferred: Academic degree in nursing (bachelor's or master's). Work Experience Required: 2 years of acute hospital patient care experience. Preferred: Acute hospital case management experience. Employment practices will not be influenced or affected by an applicant’s or employee’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.
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RN Case Manager Full Time Days. 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 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 role integrates national standards for case management scope of services including utilization management, transition management, care coordination, and compliance with regulatory requirements and Tenet policy. Education is provided to physicians, patients, families and caregivers. Responsibilities
Utilization Management: support medical necessity and denial prevention. Transition Management: promote appropriate length of stay, readmission prevention and patient satisfaction. Care Coordination: demonstrate throughput efficiency while ensuring the care is the right sequence and at the appropriate level of care. Compliance: adhere to state and federal regulatory requirements, TJC accreditation standards and Tenet policy. Education: provide education to physicians, patients, families and caregivers. Participate in accurate medical necessity screening and submission for Physician Advisor review. Coordinate care and plan transitions; assess and reassess transition planning. Oversee the implementation of transition plans and lead multidisciplinary patient care conferences. Manage concurrent disputes and make appropriate referrals to other departments. Identify and refer complex patients to Social Work Services; communicate the plan of care with patients and families. Collaborate with physicians, office staff and ancillary departments; lead Complex Case Reviews. Ensure patient education supports post-acute needs and complete documentation in the Case Management system. Maintain accurate patient demographic and insurance information; identify potentially avoidable days and report over/underutilization. Perform other duties as assigned. Qualifications
Licensure/Certification/Registration Required: RN. Must be currently licensed, certified or registered to practice as required by law or regulation in state of practice. Active RN license for state(s) covered. Preferred: Accredited Case Manager (ACM). Education Required: Graduate of an accredited school of nursing. Preferred: Academic degree in nursing (bachelor's or master's). Work Experience Required: 2 years of acute hospital patient care experience. Preferred: Acute hospital case management experience. Employment practices will not be influenced or affected by an applicant’s or employee’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.
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