Registered Nurse Case Manager II (RN) - Case Management

Conifer Health Solutions•San Antonio, TX

About The Position

Position Summary The RN Case Manager is responsible to facilitate care along a continuum through effective resource coordination to help patient achieve optimal health, access to care and appropriate utilization of resources balanced with the patient’s resources and right to self-determination. 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 provide timely throughput, safe discharge and prevent avoidable readmissions. Integrates the national standards for care 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 efficient throughput while assuring care is sequenced 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. Completes established competencies for the position within designated introductory period. Other related duties as assigned

Requirements

MINIMUM EDUCATION: Graduate of an accredited School of Nursing
MINIMUM EXPERIENCE: 2 years acute hospital patient care experience.
Utilization/case management experience.
REQUIRED CERTIFICATIONS/LICENSURE: Possession of current Texas State license for Registered Nurse

Nice To Haves

PREFERRED EDUCATION: Bachelors or Masters Degree in Nursing
PREFERRED EXPERIENCE: Previous Case Management Supervisory experience.
PREFERRED CERTIFICATIONS/LICENSURE: Accredited Case Management (ACM)

Responsibilities

facilitate care along a continuum through effective resource coordination
help patient achieve optimal health, access to care and appropriate utilization of resources balanced with the patient’s resources and right to self-determination
ensuring that care is provided at the appropriate level of care based on medical necessity
assess the patient for transition needs to provide timely throughput, safe discharge and prevent avoidable readmissions
Utilization Management supporting medical necessity and denial prevention
Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
Care Coordination by demonstrating efficient throughput while assuring care is sequenced 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
Completes established competencies for the position within designated introductory period
Other related duties as assigned