Registered Nurse (RN) - Case Manager

Tenet Healthcare; Detroit (MI); On-site; USD 75,000 - 105,000; Part time

Benefits offered by this job

Medical, dental, vision, and life保险

401(k) retirement plan with employer 2

Generous PTO

Career development opportunities

Health savings accounts

Employee Assistance program

Pet insurance

Legal insurance

Accident & critical illness insurance

Job summary

Tenet Healthcare's DMC Children's Hospital of Michigan seeks an experienced RN Case Manager to coordinate care across the continuum, ensure appropriate levels of care, and promote timely transitions and discharge planning. The role emphasizes assessments, care coordination, and collaboration with physicians, social work, and post-acute providers.

The position requires an RN license in Michigan, 2 years of acute hospital experience, and ACM preferred.

Qualifications

• Graduate from an accredited school of nursing.
• Two years of acute hospital patient care experience.
• License to practice as a Registered Nurse in the State of Michigan.
• Accredited Case Manager (ACM) preferred.
• Must complete Tenet InterQual education course within 30 days of hire and demonstrate competency in using the Tenet Case Management documentation system.

Responsibilities

• accurate medical necessity screening and submission for Physician Advisor review
• care coordination
• transition planning assessment and reassessment
• implementation or oversight of the transition plan
• leading and facilitating multi-disciplinary patient care conferences
• managing concurrent disputes
• making appropriate referrals to other departments
• identifying and referring complex patients to Social Work Services
• communicating with patients and families about the plan of care
• collaborating with physicians, office staff and ancillary departments
• leading and facilitating Complex Case Review
• assuring patient education is completed to support post-acute needs
• timely complete and concise documentation in Case Management system
• maintenance of accurate patient demographic and insurance information
• identification and documentation of potentially avoidable days
• identification and reporting over and underutilization

Education

Bachelor's degree in Nursing or other health-related field

Job description

Job Description - Registered Nurse (RN) - Case Manager (2606002625)

Registered Nurse (RN) - Case Manager

Description

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.

Benefit Statement

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

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 patients 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.

The individuals responsibilities include the following activities:

a) accurate medical necessity screening and submission for Physician Advisor review,

b) care coordination,

c) transition planning assessment and reassessment,

d) implementation or oversight 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) identifying and referring complex patients to Social Work Services,

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 Case Management system,

n) maintenance of accurate patient demographic and insurance information,

o) identification and documentation of potentially avoidable days,

p) identification and reporting over and underutilization,

q) and 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. Promotes prudent utilization of all resources (fiscal, human, environmental, equipment and services) by evaluating resources available to the patient and balancing cost and quality to assure optimal clinical and financial outcomes. 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 (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post- acute care) compared to evidence-based practice, internal and external requirements. (30% daily, essential).

Transition Management

Completes comprehensive assessment within 24 hours of patient admission to identify and document the anticipated transition plan for patients. Integrates key elements of patient assessment, patient choice and available resources to develop and implement a successful transition plan. Identifies patients at risk for readmission and applies appropriate intervention including risk assessment and referral to Social Work services and/or Complex Case Review. May delegate the implementation of the transition plan to LVN/LPN or Assistant staff. And follows up to ensure the transition plan is completed timely and accurately. Ensures all elements of the transition plan are implemented and communicated to the healthcare team, patient/family and post-acute providers. Provides information to patients to make informed choices when community services per Tenet policy. Completes Final Discharge Disposition Form Assessment for Medicare patients per Tenet policy. Identifies and reports variances in appropriateness of medical care provided, over/under utilization of resources compared to evidence-based practice and external requirements. This priority includes documentation in the Tenet Case Management system to communicating information through clear, complete and concise documentation (30% daily, essential).

Care Coordination

Screens patients for factors that may affect the progression of care and intervenes as needed to promote timely and appropriate throughput. Conducts assessments and stratifies patients at risk for readmission or in need of Case Management services. Ensures the plan of care is clinically appropriate, consistent with patient choice and available resources. Ensures consults, testing and procedures are sequenced to support the patients clinical needs with timely and efficient care delivery. Ensures patient needs are communicated and that the healthcare team is mutually accountable to achieve the patient plan of care. Effectively collaborates with physicians, nurses, ancillary staff, payors, patients and families to achieve optimum clinical outcomes (15% daily, essential).

Education

Ensures and provides education to patients, physicians and the healthcare team relevant to the- Effective progression of care, Appropriate level of care, and Safe and timely patient transition. Provides patient and healthcare team education regarding resources and benefits available to the patient along with the economic impact of care options. Ensures that education has been provided to the patient/family/caregiver by the healthcare team prior to discharge (15% daily, essential).

Compliance

Ensures compliance with federal, state, and local regulations and accreditation requirements impacting case management scope of services. Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies. Operates within the LVN/LPN scope of practice as defined by state licensing regulations. Remains current with Tenet Case Management practices (10% daily, essential).

Qualifications

1. Graduate from an accredited school of nursing. Bachelors degree in Nursing or other health-related field, or equivalent combination of education and/or related experience.

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 Tenets InterQual education course within 30 days of hire (and at least annually thereafter) and pass with a score of 85 or better. Must complete and demonstrate competency in using the Tenet Case Management documentation system within 30 days of hire. Attendance at hospital and department orientation is required. Department orientation includes review and instruction regarding Tenet Case Management and Compliance policies, InterQual, Transition Management, Utilization Management, and other topics specific to case management.

Facility Description

Children’s Hospital of Michigan is an international leader in pediatric and adolescent medicine. Surgical services include general, thoracic, reconstructive and cardiovascular. Imaging technology designed specifically for children provides advanced diagnostic services including Positron Emission Tomography (PET) and MRI. The Children’s Hospital of Michigan Emergency Department is a verified Level 1 Pediatric Trauma Center and dedicated pediatric burn center. Experts in pediatric critical care, rehabilitation, and neonatal and perinatal medicine provide care for thousands of children every year at Children’s Hospital of Michigan, Children’s Hospital of Michigan - Troy and six ambulatory sites.

EEO Statement

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.

Tenet participates in the E-Verify program.

Follow the link below for additional information. E-Verify: http://www.uscis.gov/e-verify

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Job

Case Management/Home Health

Hospital/Facility

DMC Children's Hospital of Michigan

Job Type : PT1

Shift Type : Days

Shift begin time : 8:00 AM Shift end time : 4:30 PM

Job Number

2606002625

JOIN OUR TEAM

QUALITY CARE DELIVERED BY COMPASSIONATE PEOPLE

We know it takes a special person to work in healthcare, and we are committed to providing our people with an enriching and rewarding environment. We deliver the resources, tools and support our employees need to serve our patients and customers in the best way possible — so we can create happier, healthier communities.

COMMITTED TO DIVERSITY AND INCLUSION

At Tenet, we believe in a diverse and inclusive environment, one that is grounded in our dedication to the health and well-being of all people. Respecting, nurturing and encouraging diversity of thought, background and experience contribute to positive work environments that result in exceptional patient care. We embrace diversity because it's our culture, and because it's the right thing to do.

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.

Upon receipt of a conditional offer of employment, applicant will be required to undergo a criminal background check.

Tenet participates in the E-Verify and Work Opportunity Tax Credit (WOTC) programs. Follow the links below for additional information.

E-Verify: http://www.uscis.gov/e-verify

WOTC: https://www.doleta.gov/business/incentives/opptax