Case Manager, RN - Discharge Planner

Tenet Healthcare Corporation•Sunnyvale, TX

4h•Onsite

About The Position

Baylor Scott & White Medical Center - Sunnyvale is seeking a Case Manager, RN - Discharge Planner to assess, plan, implement and evaluate the needs of patients for discharge planning and utilization review. This includes those who may have Medicare, Medicaid, HMO or private insurance to cover their stay at various units. Discharge planning is coordinated with physicians, Nursing, patient and significant others who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers. The role is based at Baylor Scott & White Medical Center-Sunnyvale in Sunnyvale, TX, a community-based hospital offering a wide range of specialties and outpatient services.

Requirements

Current Registered Nurse licensure in State of Texas.
Working knowledge of criteria for Medicare, Medicaid, HMO, Commercial, and private insurance coverage.
Experience in providing patient care.
Ability to read and communicate effectively in English.
Basic computer knowledge.
Ability to be flexible, organized and function under stressful situations.
Motivated, independent individual who can organize workload so that all functions are completed appropriately.

Nice To Haves

Additional languages preferred.

Responsibilities

Performing assessments on Medicare, Medicaid, Private Pay, Commercial insured and high-risk patients to determine discharge planning needs, always documents assessments.
Assessment of all aspects of patient care in an effort to optimize patient safety and reduces the likelihood of medical/health care errors.
Communicating with physician regarding discharge planning needs of the patient.
Assisting the physician to facilitate post-hospital care.
Maintaining current knowledge of resources available within the community, maintaining supply of resource materials to be distributed to patients when needed.
Obtaining other resources as needed.
Communicating daily with admissions personnel regarding admissions and discharges to various units, when applicable.
Initiating ongoing communication with the patient and patient’s family to assess discharge needs.
Treating patients and families with respect and dignity.
Communicating with family members and caretakers regarding the needs of the patient and anticipated plans.
Interacting professionally with patient/family and involving patient/family in the formation of the plan of care.
Documenting discharge planning in an ongoing manner.
Ensuring home care needs are met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known.
Acting on performance improvement issues identified during CQI meetings.
Cooperating with Case Manager’s activities with insurance company, based on information received.
Maintaining and respecting confidentiality of patient/physician/personnel information.
Collaborating with the Business Office Manager and onsite eligibility worker, where patients require such assistance.
Accurately determining type of assistance/setting/resources necessary for the patient/family and providing appropriate resources/assistance list of facilities.
Actively participating in Utilization Management Committee, CQI, varying team meetings and other meetings as appropriate.
Maintaining a good working relationship both within the department and with other departments.
Consulting other departments as appropriate to collaborate on patient care and performance improvement activities.
Ensuring documentation meets current standards and policies.