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.

At Tenet Healthcare, We Understand That Our Greatest Asset Is Our Dedicated Team Of Professionals. That’s Why We Offer More Than a Job – We Provide a Comprehensive Benefit Package That Prioritizes Your Health, Professional Development, And Work-life Balance. The Available Plans And Programs Include

• 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 to facilitate 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 patients resources and right to self-determination. The individual in this position 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 promote timely throughput, safe discharge and prevent avoidable readmissions.

This position integrates national standards for case 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 throughput efficiency while assuring care is the right sequence 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.

Utilization Management: Balances clinical and financial requirements and resources in advocating for patient needs with judicious resource management. Assures the patient is in the appropriate status and level of care based on Medical Necessity process and submits case for Secondary Physician review per Tenet policy. Ensures timely communication of clinical data to payers to support admission, level of care, length of stay and authorization for post-acute services.

Advocates for the patient and hospital with payers to secure appropriate payment for services rendered. Promotes prudent utilization of all resources (fiscal, human, environmental, equipment and services) by evaluating resources available to the patient and balancing cost and quality to assure optimal clinical and financial outcomes. Identifies and documents Avoidable Days using the data to address opportunities for improvement. Prevents denials and disputes by communicating with payers and documenting relevant information.

Coordinates clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post-acute care) compared to evidence-based practice, internal and external requirements.

Transition Management: Completes comprehensive assessment within 24 hours of patient admission to identify and document the anticipated transition plan for patients. Integrates key elements of patient assessment, patient choice and available resources to develop and implement a successful transition plan. Identifies patients at risk for readmission and applies appropriate intervention including risk assessment and referral to Social Work services and/or Complex Case Review.

May delegate the implementation of the transition plan to LVN/LPN or Assistant staff and…