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Overview The RN Case Manager facilitates 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 care is provided at the appropriate level based on medical necessity and to assess transition needs to promote timely throughput, safe discharge, and prevent avoidable readmissions. This role integrates national standards for case management including utilization management, transition management, care coordination, compliance with regulatory requirements, TJC accreditation standards, and Tenet policy. Education is provided to physicians, patients, families, and caregivers.
Education Required: Graduate of an accredited school of nursing
Preferred: Academic degree in nursing (bachelor\'s or master\'s)
Experience Required: 2 years of acute hospital patient care experience
Preferred: Acute hospital case management experience
Certifications Required: RN; active license to practice in state(s) covered
Preferred: Accredited Case Manager (ACM); BLS
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 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
Seniority level Associate
Employment type Temporary
Job function Health Care Provider
Industries Hospitals and Health Care and Medical Practices
Employment practices will not be influenced 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 undue hardship.
Tenet complies with federal, state, and local laws regarding mandatory vaccination of its workforce. If offered this position and required to be vaccinated, you will need to show proof of full vaccination or obtain an exemption and may be subject to regular testing if exempt.