Registered Nurse Case Manager (RN) - Case Management

Tenet Healthcare•Detroit, MI

About The Position

The RN Case Manager facilitates patient care across the continuum through effective resource coordination, helping patients achieve optimal health, access appropriate care, and use resources appropriately while respecting patient resources and self-determination. The role ensures care is provided at the appropriate level based on medical necessity and assesses transition needs to support timely throughput, safe discharge, and prevention of avoidable readmissions. The position integrates utilization management, transition management, care coordination, regulatory compliance, and education. It balances clinical and financial requirements, supports appropriate length of stay and patient satisfaction, coordinates care in the right sequence and at the appropriate level, and communicates with physicians, patients, families, caregivers, payers, and the healthcare team. The RN Case Manager also documents case management activity and supports compliance with state and federal requirements, accreditation standards, and Tenet policy. The role includes completing assessments, developing and implementing transition plans, facilitating multidisciplinary conferences and complex case reviews, identifying patients at risk for readmission, making referrals, supporting patient education, maintaining demographic and insurance information, and identifying avoidable days and resource utilization concerns. The position requires completion of Tenet InterQual education and competency in the Tenet Case Management documentation system within 30 days of hire, as well as hospital and department orientation.

Requirements

Graduate of an accredited school of nursing.
Bachelor’s degree in Nursing or another health-related field, or an equivalent combination of education and/or related experience.
Two years of acute hospital patient care experience.
Current license to practice as a Registered Nurse in the State of Michigan.
Complete Tenet’s InterQual education course within 30 days of hire and at least annually thereafter, passing with a score of 85 or better.
Complete and demonstrate competency in using the Tenet Case Management documentation system within 30 days of hire.
Attend hospital and department orientation, including instruction on Tenet Case Management and Compliance policies, InterQual, Transition Management, and Utilization Management.

Nice To Haves

Acute hospital case management experience.
Accredited Case Manager (ACM) certification.

Responsibilities

Screen cases for medical necessity, ensure appropriate patient status and level of care, and submit cases for secondary Physician Advisor review according to Tenet policy.
Communicate clinical information to payers and advocate with payers for appropriate authorization and payment.
Coordinate clinical care and resource utilization for admission, continued stay, discharge, and post-acute care.
Identify and document avoidable days, denials, disputes, and over- or underutilization of resources.
Complete a comprehensive assessment within 24 hours of admission and develop, implement, and monitor a timely transition plan.
Identify patients at risk for readmission and apply appropriate interventions, including risk assessment and referral to Social Work Services or Complex Case Review.
Communicate transition plans to the healthcare team, patients, families, and post-acute providers; provide information to support informed patient choices about community services.
Complete the Final Discharge Disposition Form Assessment for Medicare patients in accordance with Tenet policy.
Screen patients for factors affecting care progression and coordinate consults, testing, and procedures to support timely, appropriate care.
Lead and facilitate multidisciplinary patient care conferences and Complex Case Reviews.
Make appropriate referrals to other departments and refer complex patients to Social Work Services.
Collaborate with physicians, office staff, ancillary departments, payers, patients, and families to achieve optimal outcomes.
Ensure patient, physician, and healthcare-team education regarding care progression, appropriate level of care, safe transitions, available resources, benefits, and economic impacts of care options.
Ensure patient and family education is completed before discharge to support post-acute needs.
Maintain timely, complete, and concise documentation in the Tenet Case Management system and accurate patient demographic and insurance information.
Comply with federal, state, and local regulations, accreditation requirements, CMS Conditions of Participation, Tenet policies, and department procedures.
Complete required Tenet InterQual education and documentation-system competency requirements, and attend hospital and department orientation.
Perform other duties as assigned.