Registered Nurse Case Manager Lead (RN)

Abrazo Health; Phoenix (AZ); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical, dental, vision, and life insurance

401(k) retirement savings plan with employer match

Generous paid time off

Career development opportunities

Health savings accounts

Job summary

A healthcare provider in Arizona is looking for a dedicated Registered Nurse to manage the continuum of care for patients. This role involves coordinating discharge planning, educating patients, and ensuring a seamless transition to appropriate care. Candidates must have a Nursing Degree, relevant experience in acute care, and an active RN license in Arizona. Join our team to make a meaningful impact in patients' lives while enjoying great benefits and professional growth opportunities.

Qualifications

• Minimum 3 years acute care hospital experience.
• 2 years recent case management and discharge planning experience.
• Current Registered Nurse licensed in the State of Arizona.

Responsibilities

• Manage the continuum of care for assigned patients.
• Coordinate discharge planning process.
• Educate patients regarding their Medicare appeal rights.

Skills

Critical knowledge of nursing process

Excellent communication skills

Documentation skills

Education

Nursing Degree from an Accredited Nursing School

Bachelor of Science in Nursing

Tools

MIDAS

CuraSpan

InterQual

Job description

Overview

Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients' lives while enjoying a supportive work environment that fosters professional growth and work-life balance. Ready to be a vital part of our mission? Apply today and bring your passion for nursing to a place where it truly matters!

Benefits

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & 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 & childcare, auto & home insurance

Note: Eligibility for benefits may vary by location and is determined by employment status.

Job Summary

The position manages the continuum of care for assigned patients and serves as the content expert and role model for department staff. The Lead Case Manager serves as the expert in all aspects of the role including care coordination, collaboration and facilitation, advocacy for patients and families, discharge planning and utilization review. The position serves as the department expert aka "Super User" of MIDAS, CERMe, Curaspan, Portal and MS4. The Lead Case Manager has the primary responsibility for training new staff and providing education to all department staff when new initiatives are implemented. The position provides initial and annual InterQual training for RN Case Managers.

Responsibilities

• Discharge Planning - Utilize the nursing process to conduct a thorough assessment of discharge needs beginning at admission and as care needs evolve to assure a seamless and safe patient transition to the most appropriate level of care that has the identified resources to meet the medical, nursing and psychosocial needs of the patient. Collaborate with the interdisciplinary team to implement the identified discharge plan.
• Develop and effectively utilize a network of information regarding community resources.
• Coordinate the discharge planning process in collaboration with social workers and other professional members of the interdisciplinary team.
• Appropriately delegate within the scope of practice discharge planning activities and supervise others involved with discharge planning including LPNs, Case Management Coordinators or other non‑licensed personnel.
• Identify appropriate post‑hospitalization care and services required.
• Develop post hospital plan of care with the patient and/or family, physician and external resources.
• Communicate and document discharge planning needs.
• Initiate appropriate and timely social services, palliative care or other specialty referrals.
• Provide necessary patient teaching relevant to discharge needs, post hospital care arrangements prior to discharge.
• Assess the patient prior to discharge to determine if the plan is appropriate and make necessary revisions.
• Keep the interdisciplinary care team informed of details of the discharge plan.
• Communicate essential information to the next care provider as described in the hospital discharge planning policy.
• Educate patient regarding their Medicare appeal rights and initiate the Detailed Notice of Discharge (DND) when the patient decides to appeal their discharge.
• Contact the Quality Improvement Organization (QIO) per established protocol detailed in the Hospital Issued Notice of Non‑Coverage (HINN).
• Consistently apply the utilization review process in accordance with the Code of Federal Regulations and Abrazo designated criteria for primary review.
• Use clinical information to reach correct admission status determinations and work with the interdisciplinary team to ensure care and services are medically necessary, cost effective, delivered efficiently and timely.
• Coordinate internal and external services to avoid under or over utilization of resources.
• Indicate the working DRG in MIDAS or other tools.
• Facilitate or participate in interdisciplinary team meetings or rounds.
• Review records including physician orders and perform admission, concurrent discharge, and retrospective reviews as assigned.
• Communicate with physicians regarding the level of care or admission status when appropriate criteria are not met.
• Refer cases to Physician Advisor according to policy and document the referral.
• Review Observation status patients within 16 hours of admission and obtain appropriate orders based on patients’ clinical condition.
• Notify admissions office of errors or changes in patient data including changes in physician orders or incorrect admission status designation.
• Identify and document avoidable days and denials.
• Initiate appropriate letter for Medicare beneficiaries when insufficient admission or observation status criteria are met.
• Provide and document concurrent reviews or other information requested by the payer within required timeframes.
• Document insurance authorizations received in Midas or on the UM Worksheet.

Qualifications

Minimum Requirements

• Education: Nursing Degree from an Accredited Nursing School.
• MIDAS, CuraSpan and InterQual Certified Instructor (IQCI) training with proficiency testing.
• Experience: Minimum 3 years acute care hospital experience and 2 years recent acute care hospital case management, discharge planning and utilization management experience.
• Licensure/Certifications: Current Registered Nurse licensed in the State of Arizona.
• Special Skills: Critical knowledge base of nursing process, continuum of care and case management methods and standards, excellent communication and documentation skills. Demonstrates knowledge of Age‑Specific Criteria, American Nurses Association (ANA) Nursing Scope and Standards of Practice, ANA Code of Ethics for Nurses, Arizona Nurse Practice Act, Core Measures and American Case Management Association (ACMA) Case Management Standards of Practice.

Preferred Requirements

• Education: Bachelor of Science in Nursing.
• Experience: 3‑5 years experience in acute care hospital Case Management, Utilization Management and Discharge Planning, and 1 year hospital supervisory experience. Public speaking and adult education experience preferred.
• Certification/Registrations: Certified Case Manager (CCM) or Accredited Case Manager (ACM).

Equal Employment Opportunity

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.

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