Registered Nurse (RN) - Case Manager

Conifer Health Solutions•San Antonio, TX

7d•Onsite

About The Position

This position may qualify for a sign-on bonus. The Registered Nurse (RN) Case Manager 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 Case Manager integrates 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; Compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy; Education provided to physicians, patients, families, and caregivers; Provides education programs for the Case Management Department on community resources used in discharge planning; Provides reports to DCM and hospital leadership as requested; Acts as Team Leader for the discharge planning unit, providing guidance and monitoring. 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.
1 year supervisory experience.
Demonstrates computer knowledge of programs related to position and displays competency on an ongoing basis.
Current Texas State license for Registered Nurse or LMSW/LCSW

Nice To Haves

Bachelors or Masters Degree in Nursing
Previous Case Management Supervisory experience.
Certification in Case Management (CCM, ACM)

Responsibilities

Facilitate care along a continuum through effective resource coordination.
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.
Integrate national standards for care management scope of services, including Utilization Management and Transition Management.
Ensure compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy.
Provide education to physicians, patients, families, and caregivers.
Provide education programs for the Case Management Department on community resources used in discharge planning.
Provide reports to DCM and hospital leadership as requested.
Act as Team Leader for the discharge planning unit, providing guidance and monitoring.
Complete established competencies for the position within the designated introductory period.
Perform other related duties as assigned.