Registered Nurse Case Manager; RN

Position: Registered Nurse Case Manager (RN)
Who We Are

We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community.

Our Story

We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care.

We have a rich history re are so many stories of compassionate care; so many 'firsts' in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need. Tenet and our predecessors have enabled us to touch many different elements of healthcare and make a difference in the lives of others.

Our Impact Today

Today, we are leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions.

Our impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. We are differentiated by our top notch medical specialists and service lines that are tailored within each community we serve. The work Conifer is doing will help provide the foundation for better health for clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions.

Together as an enterprise, we work to save lives and can accept nothing less than excellence from ourselves in service of our patients and their families, every day.

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.

(30% daily, essential)

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 follows up to ensure the transition plan is completed timely and accurately

* Ensures all elements of the transition plan are implemented and communicated to the healthcare team, patient/family and post-acute providers

* Provides information to patients to make informed choices when community services per Tenet policy

* Completes Final Discharge Disposition Form Assessment for Medicare patients per Tenet policy

* Identifies and reports variances in appropriateness of medical care provided, over/under utilization of resources compared to evidence-based practice and external requirements. This priority includes documentation in the Tenet Case Management system to communicating information through clear, complete and concise documentation

(30% daily, essential)

Care Coordination

* Screens patients for factors that may affect the progression of care and intervenes as needed to promote timely and appropriate throughput

* Conducts assessments and stratifies patients at risk for readmission or in need of Case Management services

* Ensures the plan of care is clinically appropriate, consistent with patient choice and available resources

* Ensures consults, testing and procedures are sequenced to support the patients clinical needs with timely and efficient care delivery

*…