Registered Nurse Case Manager; RN - Case Management

Job Description – Registered Nurse Case Manager (RN) – Case Management

Job Number:

Registered Nurse Case Manager (RN) – Case Management

Are you a results‑driven leader ready to make a meaningful impact to patients, caregivers, and your community? At DMC Sinai‑Grace Hospital
, we’re seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success.

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off (PTO)
• Career development and continuing education opportunities
• Health savings accounts, healthcare C dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder C childcare, auto C home insurance

Note:

Eligibility for benefits may vary by location and is determined by employment status.

The RN Case Manager is responsible for facilitating care along the continuum through effective resource coordination to help patients achieve optimal health. The role ensures care is provided at the appropriate level based on medical necessity, assesses transition needs, promotes timely throughput, safe discharge, and prevents avoidable readmissions. It integrates national standards for case management scope of services, including utilization management, transition management, and care coordination, while complying with state and federal regulatory requirements and Tenet policy.

• Accurate medical necessity screening and submission for Physician Advisor review
• Care coordination
• Transition planning assessment and reassessment
• Implementation or oversight of the transition plan
• Leading and facilitating multi‑disciplinary patient care conferences
• Managing concurrent disputes
• Making appropriate referrals to other departments
• Identifying and referring complex patients to Social Work Services
• Communicating with patients and families about the plan of care
• Collaborating with physicians, office staff, and ancillary departments
• Leading and facilitating Complex Case Review
• Assuring patient education is completed to support post‑acute needs
• Timely complete and concise documentation in the Case Management system
• Maintaining accurate patient demographic and insurance information
• Identifying and documenting potentially avoidable days
• Identifying and reporting over and under‑utilization
• Performing other duties as assigned

Balances clinical and financial requirements, advocates for patient needs, ensures appropriate status and level of care, and submits cases for secondary physician review. Communicates with payers to support admission, length of stay, and authorizations for post‑acute services. Prevents denials and disputes by timely documentation and coordination, and promotes prudent utilization of resources.

Completes comprehensive assessment within 24 hours of admission, develops and implements the transition plan, identifies patients at risk for readmission, and applies interventions including referrals to Social Work services. Follows up to ensure timely completion, communicates the plan to the team and post‑acute providers, and completes required forms per Medicare and Tenet policy.

Screen patients for factors affecting care progression, conducts assessments, stratifies risk, ensures appropriate sequencing, and collaborates with the entire healthcare team to achieve optimal outcomes.

Provides education to patients, physicians, and the team regarding appropriate level of care, patient transition, resources, and the economic impact of care options.

Ensures compliance with federal, state, and local regulations and accreditation requirements. Adheres to department structure, policies, and procedures, and stays current with Tenet Case Management practices and state licensing regulations.