Case Manager Jobs

About The Position

Requirements

• Graduate from 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.
• 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

• Conduct accurate medical necessity screening and submit cases for Physician Advisor review.
• Coordinate care and assess patients for factors that may affect care progression, throughput, or readmission risk.
• Complete and reassess transition-planning assessments, including a comprehensive assessment within 24 hours of admission.
• Develop, implement, or oversee implementation of transition plans, and follow up to ensure timely and accurate completion.
• Lead and facilitate multidisciplinary patient care conferences and Complex Case Review.
• Manage concurrent disputes and communicate with payers to support appropriate payment and prevent denials.
• Make appropriate referrals to other departments and refer complex patients to Social Work Services when indicated.
• Communicate the plan of care with patients and families and collaborate with physicians, office staff, ancillary departments, payers, and the healthcare team.
• Ensure patient education is completed to support post-acute needs and safe transitions.
• Maintain timely, complete, and concise documentation in the Case Management system.
• Maintain accurate patient demographic and insurance information.
• Identify and document potentially avoidable days and report over- or underutilization.
• Balance clinical and financial requirements and promote prudent use of fiscal, human, environmental, equipment, and service resources.
• Ensure care is at the appropriate status and level based on medical necessity, and submit cases for secondary Physician review per Tenet policy.
• Communicate clinical data to payers in a timely manner to support admission, level of care, length of stay, and authorization for post-acute services.
• Coordinate clinical care for admission, continued stay, discharge, and post-acute care in accordance with evidence-based practice and applicable requirements.
• Identify patients at risk for readmission and apply appropriate interventions, including risk assessment and referral to Social Work Services or Complex Case Review.
• Ensure transition-plan elements are communicated to the healthcare team, patient or family, and post-acute providers; provide information to patients to support informed choices about community services.
• Complete the Final Discharge Disposition Form Assessment for Medicare patients per Tenet policy.
• Ensure consults, testing, and procedures are sequenced to support patients’ clinical needs and efficient care delivery.
• Provide or ensure education for patients, physicians, and the healthcare team regarding progression of care, appropriate level of care, safe transitions, available resources and benefits, and the economic impact of care options.
• Ensure compliance with federal, state, and local regulations, accreditation requirements, CMS Conditions of Participation, and Tenet policies.
• Remain current with Tenet Case Management practices and operate within applicable scope-of-practice requirements.
• Perform other duties as assigned.

Benefits

• Sign-on bonus up to $25,000, based on relevant experience.