Registered Nurse Case Manager (RN) FT days

Conifer Health Solutions•San Antonio, TX

3d•Onsite

About The Position

This position 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 role 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. The position 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 the appropriate level of care; Compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy; and Education provided to physicians, patients, families, and caregivers. Completes established competencies for the position within the designated introductory period. Other related duties as assigned.

Requirements

Graduate of an accredited School of Nursing
2 years acute hospital patient care experience.
Utilization/case management experience.
Current Texas State license for Registered Nurse
CPR certification

Nice To Haves

Bachelors or Masters Degree in Nursing
Previous Case Management Supervisory experience.
Accredited Case Management (ACM) certification

Responsibilities

Facilitate care along a continuum through effective resource coordination.
Help patients achieve optimal health, access to care, and appropriate utilization of resources.
Ensure care is provided at the appropriate level of care based on medical necessity.
Assess patients for transition needs to provide timely throughput, safe discharge, and prevent avoidable readmissions.
Perform Utilization Management supporting medical necessity and denial prevention.
Perform Transition Management promoting appropriate length of stay, readmission prevention, and patient satisfaction.
Perform Care Coordination by demonstrating efficient throughput while assuring care is sequenced and at appropriate level of care.
Ensure compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy.
Provide education to physicians, patients, families, and caregivers.
Complete established competencies for the position within the designated introductory period.
Perform other related duties as assigned.