RN Case Manager I FT Days

Description

RN Case Manager I Full Time Days Position Summary

The individual in this position 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 patient’s resources and right to self-determination. The individual in this position has overall responsibility to ensure that care is provided at the appropriate level of care based on medical necessity and 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 efficient throughput while assuring care is sequenced and at the 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

· Provides educational programs for Case Management Department on community resources use in discharge planning

· Provides reports to Director of Case Management (DCM) and hospital leadership as requested

· Provides management of the department, but not limited to, hiring/training/managing staff, schedule coordination, analysis and reporting, interfacing, collaborating and working closely with the other departments The individual’s responsibilities include the following activities: a) assist the DCM in the daily operations of the department b) transition planning assessment and reassessment, d) implementation or oversight of implementation of the transition plan, e) leading and facilitating multi-disciplinary patient care conferences, f) managing concurrent disputes, g) making appropriate referrals to other departments, h) identification and reporting over and underutilization, i) communicating with patients and families about the plan of care, j) collaborating with physicians, office staff and ancillary departments, k) leading and facilitating Complex Case Review, l) assuring patient education is completed to support post-acute needs , m) timely complete and concise documentation in Tenet Case Management documentation system, n ) maintenance of accurate patient demographic and insurance information, o) identification and documentation of potentially avoidable days, p) and other duties as assigned.