Registered Nurse Case Manager (RN)

Tenet Healthcare Corporation•San Ramon, CA

216d

About The Position

San Ramon Regional Medical Center began serving residents of the San Ramon Valley and its surrounding communities in 1990. Located on a hillside overlooking the valley, we are a 123-bed, acute-care hospital, primary stroke center, and a cardiac heart surgery hospital. San Ramon Regional Medical Center provides comprehensive inpatient and outpatient services. Personalized service and a patient-centered philosophy are distinctive qualities of our facility. We offer competitive salaries and benefits including a matching 401(k), several health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions. Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services Wellbeing support, including employee assistance program (EAP) Time away from work programs for paid time off, long- and short-term plan coverage Savings and retirement including a 401(k) Plan with a 50% match up to 6% of pay, employee stock purchase plan, flexible spending accounts, retirement readiness tools, rollover support, and financial well-being counseling Education support through tuition assistance, student loan assistance, certification support, and online educational program Additional benefits life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and employee discount program Registered nurses – Retirement medical benefit account (RMBA) – 2% of annual eligible income set aside in accordance with program guidelines Benefits may vary by location and role SUMMARY: 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 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 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 The individual’s responsibilities include the following activities: a) accurate medical necessity screening and submission for Physician Advisor review, b) care coordination, c) transition planning assessment and reassessment, d) implementation or oversight of implementation of the transition plan, e) leading and facilitating multi-disciplinary patient care conferences, f) managing concurrent disputes, g) making appropriate referrals to other departments, h ) identifying and referring complex patients to Social Work Services, i) communicating with patients and families about the plan of care, j) collaborating with physicians, office staff and ancillary departments, k) leading and facilitating Complex Case Review, l) assuring patient education is completed to support post-acute needs , m) timely complete and concise documentation in Case Management system, n ) maintenance of accurate patient demographic and insurance information, o) identification and documentation of potentially avoidable days, p) identification and reporting over and underutilization, q) and other duties as assigned.

Responsibilities

accurate medical necessity screening and submission for Physician Advisor review
care coordination
transition planning assessment and reassessment
implementation or oversight of implementation 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
assuring 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

Benefits

competitive salaries
matching 401(k)
health & dental plans
generous tuition assistance plans
relocation assistance
medical, prescription drug, dental, vision, behavioral health and telemedicine services
employee assistance program (EAP)
paid time off, long- and short-term plan coverage
401(k) Plan with a 50% match up to 6% of pay
employee stock purchase plan
flexible spending accounts
retirement readiness tools
rollover support
financial well-being counseling
student loan assistance
certification support
online educational program
life insurance
supplemental health protection plans
auto and home insurance
legal counseling
identity theft protection
employee discount program
Retirement medical benefit account (RMBA) – 2% of annual eligible income set aside in accordance with program guidelines