Primary Duties 

1. Utilization Management supporting medical necessity and denial prevention. 
2. Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction.
3. Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care. 
4. Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy. 
5. Education provided to physicians, patients, families and caregivers.
6. Accurate medical necessity screening and submission for Physician Advisor review.
7. Timely complete and concise documentation in Case Management system.
8. Maintenance of accurate patient demographic and insurance information.
9. Identification and documentation of potentially avoidable days. 
10. Identification and reporting over and underutilization. 
11. Other duties as assigned.

Minimum Education/Certification/Experience:

• CA Registered Nurse license
• At least two years acute hospital patient care experience 
• BSN preferred
• Accredited Case Manager (ACM) preferred
• Acute hospital case management experience preferred
• Required skills include demonstrated organizational skills
• Excellent verbal and written communication skills

#LI-DH1

Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.