Registered Nurse (RN) - Case Management - $31+ per hour

Detroit Medical Center; Detroit (MI); On-site; Full time

Job summary

An established industry player in healthcare is looking for a dedicated Registered Nurse (RN) specializing in Case Management. This role is vital for coordinating patient care and ensuring optimal health outcomes through effective resource management and compliance with medical standards. The RN will assess patient needs, manage transitions, and advocate for patients while collaborating with a multidisciplinary team. This position offers a chance to make a significant impact in the lives of patients and their families in a supportive and dynamic environment. Join a team committed to excellence and innovation in healthcare delivery.

Benefits

Medical benefits

Dental benefits

Vision benefits

Employee assistance programs

Life insurance

Discount program

Qualifications

• Must be a graduate from an accredited nursing school with a Bachelor's degree.
• Two years of acute hospital patient care experience required.

Responsibilities

• Facilitate care coordination and transition planning for patients.
• Ensure compliance with medical necessity and regulatory requirements.
• Educate patients and healthcare teams on effective care progression.

Skills

Care Coordination

Patient Advocacy

Utilization Management

Transition Management

Documentation Skills

Education

Bachelor's degree in Nursing

Graduate from an accredited school of nursing

Job description

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Registered Nurse (RN) - Case Management - $31+ per hour New

Detroit Medical Center is seeking a Registered Nurse (RN) Case Management for a nursing job in Detroit, Michigan.

Job Description & Requirements

• Specialty: Case Management
• Discipline: RN
• Duration: Ongoing
• 36 hours per week
• Shift: 12 hours, days
• Employment Type: Staff

**Up to $25,000 Sign on Bonus, based on relevant experience**

DMC Harper University Hospital has distinguished itself in surgery and medicine and is known for its clinical expertise and innovative research.

POSITION SUMMARY:

The RN Case Manager 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 for ensuring that care is provided at the appropriate level of care based on medical necessity and to 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 throughput efficiency while assuring care is the right sequence and at 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.

Responsibilities include:

1. Accurate medical necessity screening and submission for Physician Advisor review.
2. Care coordination and transition planning assessment and reassessment.
3. Implementation or oversight of the transition plan.
4. Leading and facilitating multi-disciplinary patient care conferences.
5. Managing concurrent disputes and making appropriate referrals to other departments.
6. Identifying and referring complex patients to Social Work Services.
7. Communicating with patients and families about the plan of care.
8. Collaborating with physicians, office staff and ancillary departments.
9. Leading and facilitating Complex Case Review.
10. Assuring patient education is completed to support post-acute needs.
11. Timely complete and concise documentation in Case Management system.
12. Maintenance of accurate patient demographic and insurance information.
13. Identification and documentation of potentially avoidable days.
14. Identification and reporting over and underutilization.
15. Other duties as assigned.

POSITION SPECIFIC RESPONSIBILITIES:

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.
• 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 compared to evidence-based practice, internal and external requirements.

Transition Management:

• Completes comprehensive assessment within 24 hours of patient admission to identify and document the anticipated transition plan for patients.
• Identifies patients at risk for readmission and applies appropriate intervention.
• Ensures all elements of the transition plan are implemented and communicated.
• Completes Final Discharge Disposition Form Assessment for Medicare patients per Tenet policy.

Care Coordination:

• Screens patients for factors that may affect the progression of care and intervenes as needed.
• Conducts assessments and stratifies patients at risk for readmission.
• Ensures consults, testing and procedures are sequenced to support the patients clinical needs.
• Effectively collaborates with physicians, nurses, ancillary staff, payors, patients and families.

Education:

• Ensures and provides education to patients, physicians and the healthcare team relevant to the effective progression of care.
• Provides patient and healthcare team education regarding resources and benefits available to the patient.
• Ensures that education has been provided to the patient/family/caregiver prior to discharge.

Compliance:

• Ensures compliance with federal, state, and local regulations and accreditation requirements.
• Adheres to department structure and staffing, policies and procedures.

Qualifications:

1. Graduate from an accredited school of nursing. Bachelor's degree in Nursing or other health-related field.
2. Two years of acute hospital patient care experience. Acute hospital case management experience preferred.
3. License to practice as a Registered Nurse in the State of Michigan.
4. Accredited Case Manager (ACM) preferred.
5. Must complete Tenet's InterQual education course within 30 days of hire.

Job: Case Management/Home Health Primary Location: Detroit, Michigan Facility: DMC Harper University/Hutzel Women's Hospital Job Type: Full Time Shift Type: Day

Detroit Medical Center Job ID #4369-2506000627-1. Posted job title: RN Case Manager Adult Services Full Time Days

About Detroit Medical Center

The Detroit Medical Center (DMC) is the leading academically–integrated hospital system in Metro Detroit, and one of the largest health care providers in Southeast Michigan.

At the DMC, we are committed to maintaining an environment of Equal Opportunity and Affirmative Action.

Employee Benefits

• Medical benefits
• Dental benefits
• Vision benefits
• Employee assistance programs
• Life insurance
• Discount program