Registered Nurse (RN) Case Manager
About The Position
The RN Case Manager facilitates care along a continuum through effective resource coordination, helping patients achieve optimal health, access care, and use resources appropriately while respecting their resources and right to self-determination. The role is responsible for ensuring care is provided at the appropriate level based on medical necessity and assessing transition needs to support timely throughput, safe discharge, and prevention of avoidable readmissions. The position integrates national case management standards across utilization management, transition management, care coordination, regulatory and accreditation compliance, and education. This includes supporting medical necessity and denial prevention; promoting appropriate length of stay, readmission prevention, and patient satisfaction; ensuring efficient throughput and appropriate care sequencing and levels; complying with state and federal regulations, TJC accreditation standards, and Tenet policy; and educating physicians, patients, families, and caregivers.
Requirements
- Graduate of an accredited school of nursing.
- Two years of acute hospital patient care experience.
- Current RN licensure, certification, or registration as required by law or regulation in the state of practice or policy.
- Active RN license for the state(s) covered.
Nice To Haves
- Academic degree in nursing (bachelor's or master's).
- Acute hospital case management experience.
- Accredited Case Manager (ACM) certification.
Responsibilities
- Perform accurate medical necessity screening and submit cases for Physician Advisor review.
- Identify and refer complex patients to Social Work Services.
- Collaborate with physicians, office staff, and ancillary departments.
- Complete timely, concise documentation in the Case Management system.
- Identify and document potentially avoidable days.
- Identify and report overutilization and underutilization.
- Assess patient transition needs to promote timely throughput, safe discharge, and prevention of avoidable readmissions.
- Support appropriate length of stay, readmission prevention, patient satisfaction, and care coordination.
- Educate physicians, patients, families, and caregivers.
- Perform related duties as required.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
