Staff - Registered Nurse (RN) - Case Management - $31-42 per hour

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

DMC Sinai-Grace Hospital is DMC’s largest hospital, offering a comprehensive heart center, cancer care, gerontology, emergency medicine, obstetrics / gynecology and cosmetic services. Sinai-Grace’s joint replacement program features a revolutionary minimally invasive knee and hip replacement surgery that attracts patients from all over the country. Sinai-Grace operates more than 21 outpatient care sites and ambulatory surgery centers throughout Wayne and Oakland Counties and is one of 10 hospitals in the nation to be awarded a Robert Wood Johnson Foundation grant to help set the standards of cardiac care for hospitals and physicians throughout the nation.

Job 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 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 implementation 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.

Job : Case Management / Home Health Primary Location : Detroit, Michigan Facility : DMC Sinai-Grace Hospital Job Type : Full Time Shift Type : Day

Detroit Medical Center Job ID #4369-2506002554-2. Posted job title : RN Case Manager CRM 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. During our 150+ years of caring for the community, we have been recognized nationally with top awards in many aspects of hospital operations and patient care. The DMC is able to achieve these awards because of our exceptional employees.

The Detroit Medical Center is one the largest academic medical centers in the United States, with a long and rich history of medical education, for more than 100 years. We train more physicians than any other hospital in Detroit.

Our evidence-based approach inspires confidence and spurs innovation. It ensures that we are making treatment decisions based on our experience, on the best available research and our understanding of each patient as an individual.

Our commitment to our patients

Our commitment to patient care and improving patient outcomes is part of everything we do. It’s our mission. It’s our promise to every patient and every family who entrusts their care to us.

To meet the needs of our community, we operate 8 hospitals and more than 140 clinics and outpatient facilities across southeast Michigan, including a nationally recognized dedicated pediatric hospital (Children’s Hospital of Michigan) as well as a nationally recognized rehabilitation hospital (Rehabilitation Institute of Michigan). We offer an inclusive, diverse and supportive environment. Knowing that we are better together, our teams are highly collaborative and integrated to deliver the high quality and compassionate care our patients expect and deserve. Staff members have a voice in forming our culture; one that is often referred to as “my forever family” and “colleagues who have my back”.

The DMC has a proud legacy of caring for the people and the families that call Metro Detroit home; they’re our neighbors, our friends, and our community. That’s why the DMC serves everyone in the community who needs us; no one gets turned away who comes to us for care. From local food drives to our long-standing commitment to educate and empower our community towards better health, you can count on the DMC. There’s a spirit of caring and togetherness that you will experience when you join the DMC family. We are a community build on care.

At the DMC, we are committed to maintaining an environment of Equal Opportunity and Affirmative Action. If you need a reasonable accommodation to access the information provided on this web site, please contact the DMC facility where the position is available, for further assistance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran status or status as an individual disability.

Employee Benefits

At the DMC, health and well-being are important to us, so we provide a range of benefits and options to help meet the needs of all eligible employees. In addition to a range of healthcare plans, including higher and lower deductible options, we offer dental, vision and an employee assistance plan. Basic life insurance and Accidental Death and Dismemberment insurance are provided for free to eligible plan members. Employees can also choose to participate in one of several supplemental life insurance and / or disability plans, a legal services plan and an identity protection plan. For those employees who are looking for support to care for family members, we also offer child and elder care programs.

To help employees prepare for retirement, we offer a 401K savings plan, and an employee discount plan that includes discounts for a wide variety of products, including auto and home insurance and mobile plans.

Benefits