Registered Nurse Case Manager (RN)
About The Position
The individual in this position has overall responsibility for overseeing the clinical plan of care to conform to evidence-based practice and regulatory requirements. This position integrates care coordination, utilization management, and discharge planning. The individual’s responsibilities will include, but not be limited to, medical necessity screening, care coordination, discharge planning, facilitating multi-disciplinary patient care conferences, managing concurrent disputes, making appropriate referrals to other departments (e.g., nutrition, PT/OT/ST), referring complex social issues to Social Service, communicating with patients and their families about the plan of care, collaborating with physicians, office staff and ancillary departments (e.g., lab, pharmacy), participating in weekly Complex Case Review, arranging for post-discharge patient education, clear, complete and concise documentation in eCCM, maintaining accuracy of patient demographic and insurance information, identifying and documenting potentially avoidable days, identifying and reporting over and under utilization, and other duties as assigned. Attends hospital workshop led by the Director of Case Management or designee that includes the Tenet Case Management Model, InterQual, Discharge Planning, Utilization Management, and other topics specific to case management. Extended orientation with selected Case Managers may occur. Information used to perform job: patient data, healthcare staff documentation related to patient care, regulatory and payor requirements. Software used to perform job: eCCM: Clinical data interface, InterQual, Case Management documentation, secure faxing, Avoidable Day tracking, Patient Medical Record and HPF, Hospital specific Clinical Software.
Requirements
- Registered Nurse Case Manager (RN)
- Patient data
- Healthcare staff documentation related to patient care
- Regulatory and payor requirements
- eCCM: Clinical data interface
- InterQual
- Case Management documentation
- Secure faxing
- Avoidable Day tracking
- Patient Medical Record and HPF
- Hospital specific Clinical Software
Responsibilities
- Overseeing the clinical plan of care to conform to evidence-based practice and regulatory requirements.
- Integrating care coordination, utilization management, and discharge planning.
- Medical necessity screening
- Care coordination
- Discharge planning
- Facilitating multi-disciplinary patient care conferences
- Managing concurrent disputes
- Making appropriate referrals to other departments (e.g., nutrition, PT/OT/ST)
- Referring complex social issues to Social Service
- Communicating with patients and their families about the plan of care
- Collaborating with physicians, office staff and ancillary departments (e.g., lab, pharmacy)
- Participating in weekly Complex Case Review
- Arranging for post-discharge patient education
- Clear, complete and concise documentation in eCCM
- Maintaining accuracy of patient demographic and insurance information
- Identifying and documenting potentially avoidable days
- Identifying and reporting over and under utilization
- Attending hospital workshop led by the Director of Case Management or designee that includes the Tenet Case Management Model, InterQual, Discharge Planning, Utilization Management, and other topics specific to case management.
- Participating in extended orientation with selected Case Managers.
Benefits
- Medical, dental, vision, and life insurance
- 401(k) retirement savings plan with employer match
- Generous paid time off
- Career development and continuing education opportunities
- Health savings accounts, healthcare & dependent flexible spending accounts
- Employee Assistance program, Employee discount program
- Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
