Case Manager, RN PRN Days

Tenet Healthcare; Sunnyvale (TX); On-site; USD 60,000 - 90,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated Case Manager RN I to enhance patient care through effective discharge planning and utilization review. This role emphasizes collaboration with physicians, nursing staff, and families to ensure that patients receive the necessary support and resources for a smooth transition from hospital to home. The ideal candidate will possess a current RN licensure in Texas and demonstrate strong communication and organizational skills. Join a dynamic team committed to optimizing patient outcomes and making a meaningful impact in the community.

Qualifications

• Current RN licensure in Texas is required.
• Experience in patient care and knowledge of insurance criteria is essential.

Responsibilities

• Perform assessments for discharge planning and document findings.
• Communicate with physicians and families about patient needs.
• Participate in Utilization Management Committee and maintain documentation.

Skills

Patient Assessment

Communication Skills

Knowledge of Medicare/Medicaid

Organizational Skills

Flexibility

Bilingual (preferred)

Education

Registered Nurse Licensure in Texas

Tools

Basic Computer Knowledge

Job description

Baylor Scott & White Medical Center - Sunnyvale is seeking a Case Manager RN I to assess, plan, implement and evaluate the needs of patients for discharge planning and utilization review. This includes those who may have Medicare, Medicaid, HMO or private insurance to cover their stay at various units. Discharge planning is coordinated with physicians, Nursing, patient and significant others who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers.

What Your Day Will Look Like

• Responsible for performing assessments on Medicare, Medicaid, Private Pay, Commercial insured and high-risk patients to determine discharge planning needs, always documents assessments.
• Responsible for assessment of all aspects of patient care in an effort to optimize patient safety and reduces the likelihood of medical/health care errors.
• Able to communicate with physician regarding discharge planning needs of the patient. Assists the physician to facilitate post-hospital care.
• Is knowledgeable of criteria for Medicare, Medicaid, Commercial and private insurance coverage.
• Maintains current knowledge of resources available within the community, maintains supply of resource materials to be distributed to patients when needed. Is able to obtain other resources as needed.
• Communicates daily with admissions personnel regarding admissions and discharges to various units, when applicable.
• Initiates ongoing communication with the patient and patient’s family to assess discharge needs.
• Treats patients and families with respect and dignity.
• Communicates with family members and caretakers regarding the needs of the patient and anticipated plans.
• Interacts professionally with patient/family and involves patient/family in the formation of the plan of care.
• Documents discharge planning in an ongoing manner.
• Is knowledgeable of patient’s financial status, diagnosis and discharge needs.
• Is responsible for home care needs being met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known.
• Acts on performance improvement issues identified during CQI meetings.
• Cooperates with Case Manager’s activities with insurance company, based on information received.
• Maintains and respects confidentiality of patient/physician/personnel information.
• Collaborates with the Business Office Manager and onsite eligibility worker, where patients require such assistance.
• Accurately determines type of assistance/setting/resources necessary for the patient/family and provides appropriate resources/assistance list of facilities.
• Actively participates in Utilization Management Committee, CQI, varying team meetings and other meetings as appropriate.
• Demonstrates an ability to be flexible, organized and function under stressful situations.
• Maintains a good working relationship both within the department and with other departments.
• Consults other departments as appropriate to collaborate on patient care and performance improvement activities.
• Documentation meets current standards and policies.

Success Factors

• Current Registered Nurse licensure in State of Texas.
• Is a motivated, independent individual who can organize workload so that all functions are completed appropriately.
• Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.
• Experience in providing patient care.
• Ability to read and communicate effectively in English.
• Additional languages preferred.
• Basic computer knowledge.