Registered Nurse Case Manager (RN)

Conifer Health Solutions•San Antonio, TX

About The Position

Responsible to facilitate care along a continuum through effective resource coordination to help patient achieve optimal health, access to care and appropriate utilization of resources balanced with the patient’s resources and right to self-determination. 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. 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 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. Completes established competencies for the position within 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

Nice To Haves

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

Responsibilities

Facilitate care along a continuum through effective resource coordination.
Ensure patient achieves optimal health, access to care, and appropriate utilization of resources.
Balance patient resources and right to self-determination.
Ensure care is provided at the appropriate level of care based on medical necessity.
Assess patient for transition needs to provide timely throughput, safe discharge, and prevent avoidable readmissions.
Integrate national standards for care management scope of services including Utilization Management, Transition Management, and Care Coordination.
Support medical necessity and denial prevention.
Promote appropriate length of stay, readmission prevention, and patient satisfaction.
Demonstrate efficient throughput while assuring care is sequenced and at the 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.