Tenet Healthcare
Overview
RN Case Manager I FT Days role at Tenet Healthcare – Saint Francis Hospital Memphis. Saint Francis Hospital Memphis is a 510-bed acute care hospital dedicated to providing high quality, compassionate care to the Mid-South community. As a comprehensive medical center, Saint Francis Hospital Memphis features a broad spectrum of tertiary and acute care, outpatient services and specialty areas including Women’s Services, Surgical Services, Bariatric Center of Excellence and Behavioral Health. Other acute care areas include Emergency Room, Critical Care, Med/Surg and Telemetry.
Position Summary
The RN Case Manager is responsible for facilitating 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, transition management, care coordination, and compliance with regulatory requirements.
Responsibilities
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
Accurate medical necessity screening and submission for Physician Advisor review
Care coordination
Transition planning assessment and reassessment
Implementation or oversight of the transition plan
Leading and facilitating multi-disciplinary patient care conferences
Managing concurrent disputes
Making appropriate referrals to other departments
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
Ensuring patient education is completed to support post-acute needs
Timely complete and concise documentation in Case Management system
Maintenance of accurate patient demographic and insurance information
Identification and documentation of potentially avoidable days
Identification and reporting over and underutilization
Other duties as assigned
Qualifications
Education Required:
Graduate of an accredited School of Nursing
Experience Required:
Two (2) years acute hospital patient care experience. Preferred: Acute hospital case management experience.
Experience Preferred:
Three (3) years acute care experience relevant to the area of specialty; two (2) years of case management experience. Ability to prepare reports and formal presentations; utilization management experience.
Certifications:
BLS certification required. ACLS required within 3 months of hire for ED, ICU, SDU, HS, FLOAT, TELE, MS, GIL, IR, L&D, PACU, and SDS. PALS or ENPC required within 3 months of hire for ECC, PACU, HS, SDS and Float. CPI required for ED, Float, NA and HS. NRP required within 3 months of hire for LD and NICU. Preferred: Accredited Case Manager (ACM).
Employment details
Seniority level: Executive
Employment type: Full-time
Job function: Health Care Provider
Industries: Hospitals and Health Care and Medical Practices
Equal Employment Opportunity statement: 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.
We’re unable to provide links or references outside of this description. Referrals increase your chances of interviewing at Tenet Healthcare.
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Position Summary
The RN Case Manager is responsible for facilitating 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, transition management, care coordination, and compliance with regulatory requirements.
Responsibilities
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
Accurate medical necessity screening and submission for Physician Advisor review
Care coordination
Transition planning assessment and reassessment
Implementation or oversight of the transition plan
Leading and facilitating multi-disciplinary patient care conferences
Managing concurrent disputes
Making appropriate referrals to other departments
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
Ensuring patient education is completed to support post-acute needs
Timely complete and concise documentation in Case Management system
Maintenance of accurate patient demographic and insurance information
Identification and documentation of potentially avoidable days
Identification and reporting over and underutilization
Other duties as assigned
Qualifications
Education Required:
Graduate of an accredited School of Nursing
Experience Required:
Two (2) years acute hospital patient care experience. Preferred: Acute hospital case management experience.
Experience Preferred:
Three (3) years acute care experience relevant to the area of specialty; two (2) years of case management experience. Ability to prepare reports and formal presentations; utilization management experience.
Certifications:
BLS certification required. ACLS required within 3 months of hire for ED, ICU, SDU, HS, FLOAT, TELE, MS, GIL, IR, L&D, PACU, and SDS. PALS or ENPC required within 3 months of hire for ECC, PACU, HS, SDS and Float. CPI required for ED, Float, NA and HS. NRP required within 3 months of hire for LD and NICU. Preferred: Accredited Case Manager (ACM).
Employment details
Seniority level: Executive
Employment type: Full-time
Job function: Health Care Provider
Industries: Hospitals and Health Care and Medical Practices
Equal Employment Opportunity statement: 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.
We’re unable to provide links or references outside of this description. Referrals increase your chances of interviewing at Tenet Healthcare.
#J-18808-Ljbffr