RN Case Manager I Full Time Days

Up to $20,000 Sign-On bonus for experienced Registered Nurse / RN

POSITION SUMMARY

Responsible for coordinating, developing, executing, monitoring, and evaluating all Case Management activities. Case Management activities encompass : utilization review, resource management, coordination of care, transition / discharge planning, across the episode of care.

Working in collaborative practice with the physician and other members of the health care team to meet patient-specific and age- related patient needs, linking cost resource management and quality to patient care.

Completes established competencies for the position within designated introductory period. Other related duties as assigned.

POSITION QUALIFICATIONS

MINIMUM EDUCATION : Graduate of an accredited School of Nursing

PREFERRED EDUCATION : Bachelors or Masters Degree in Nursing. May substitute experience for degree.

MINIMUM EXPERIENCE : 2 years of recent acute care nursing experience. Working knowledge of computers and basic software applications used in job functions such as word processing, graphics, databases, spreadsheets, etc.

PREFERRED EXPERIENCE : 2 years in Utilization Review, Discharge planning and Medical case management ina hospital setting.

Strong organizational skills. Knowledge of specific regulatory, managed care requirements.

REQUIRED CERTIFICATIONS / LICENSURE : Possession of current Texas State license for Registered Nurse

PREFERRED CERTIFICATIONS / LICENSURE : Certified in Case Management

REQUIRED COURSES / COMPLETIONS (., CPR) : BLS-obtained through approved American heart Association Training Center

LI-SC1

Tenet complies with federal, state, and / or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date.

If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

Utilization Management, Care Coordination, and Transition Management : Manages patient care provided to an assigned population, determines appropriateness of hospitalization based on criteria / evidence, coordinates discharge / transfer plan, and provides guidance and intervenes as needed.

Conducts utilization review / management as outlined in the UR Plan and assigned duties.

Performs initial review same day, no later than next day, evaluating patient’s condition and treatment plan for medical necessity, clinical appropriateness, completeness, and progression;

Initiates timely transition / discharge planning.

Anticipates an appropriate length of stay based on the initial review and plans concurrent reviews accordingly.

Using established criteria reviews for appropriateness of continued stay and transition readiness ensuring all days are covered (approved for reimbursement).

Accepts no pended days from payers.

Complies with all utilization review regulations and payer contracting agreements. (. Medicare Hospital Issued Notices of Non-Coverage, Detailed Notice of Discharge)

Facilitates the patient's plan of care in a proactive manner providing any necessary anticipatory guidance to the healthcare team members and patients / family.

Reviews the patient’s plan of care with the patient’s physicians, Social Worker, nurses, healthcare team, and payer (as applicable).

Offers suggestions, coordinates care, determines the transition plan with the interdisciplinary team, identifies and resolves variances.

Works to avoid or overturns payer or internal denials concurrently by proactively resolving any clinical and operational barriers.

Works collaboratively with the Social Worker and refers complex home discharges and placements.

Utilizes the client-hospitals designated physician advisor(s) to address challenges, provide education, and address internal barriers.

Coordinates patient care conferences, as necessary.

Directs referrals appropriately to quality manager, financial counselor, social workers, case management assistant, etc.

and works collaboratively to achieve patient care goals.

Serves as a consultant to staff, physicians, management and other health care professionals sharing knowledge regarding standards of care and best practices to ensure successful implementation of the patient’s plan of care.

Collaborates with all disciplines to address cost reduction opportunities related to use of resources.

Ensures timely execution of the patient’s discharge / transfer plan.

Documents appropriate interventions in the patient’s medical record and Case Management information system.

Other duties as assigned.

Outcomes Management : Initiates and contributes to modifications and changes in practice patterns to optimize patient outcomes, achieve quality of care goals, patient satisfaction, and appropriate use of resources.

Collects, utilizes, and trends process and outcomes data for identification of problems related to efficiency and quality of care issues as directed by the Hospital Case Management (HCM) leader.

Trends, analyzes, and reports outcomes, clinical process and variance data to appropriate audiences.

Analyzes cost factors related to patient outcomes and make recommendations for change in clinical practice as appropriate to support the financial and clinical imperatives of the Hospital.

Participates in process and outcome improvement activities, such as protocol development, and helps facilitate approved practice changes.

For assigned population attends appropriate physician and Nurse leader meetings to report on trends, outcomes and statistics.

Receives and acts on feedback from physicians and nursing management related to Case Management.

Identifies opportunities for HCM program refinement and improvement.

Practices sound fiscal management while respecting the quality goals of Conifer Revenue Cycle Solutions and the client-hospital.

Achieves length of stay and resource consumption targets for the assigned patient population.

Completes reports and tasks within designated timeframes.

Provides training and support to health care team members regarding their documentation to accurately reflect patient’s condition and intensity of service.

Excellence in Service

Maintains skills and knowledge base in HCM specialty; adheres to HCM related policies and practices; Adheres to HCM department standards.

Applies knowledge of current and evidenced based practices in execution of duties and responsibilities.

Maintains proficiency with the use of screening criteria as evidenced by a passing score on the competency exam, inter-rater reliability testing and sample audits of documentation.

Demonstrates positive interpersonal and communication skills in interactions with patients, families, physicians, interdisciplinary team members and agencies.

Works collaboratively with healthcare team to achieve patient and hospital outcome goals.

Educates health care team members regarding care issues of defined patient population.

Implements appropriate follow-up to identified problems / events.

Shares knowledge regarding quality measures and identifies and addresses quality of care concerns.

Works collaboratively with HCM leader and department staff to evaluate and improve the services and support offered by the HCM department.

Participates in HCM department quality monitoring and takes corrective action as directed by department leader to improve performance.

Takes initiative in making suggestions for improvement of department services.

Contributes to new HCM employee orientation.

Prioritizes responsibilities in order to achieve desired results in the necessary timeframe.

Assists in the development of patient education programs.

Assumes responsibility for delivery of department services as part of the team effort in the HCM department.

Develops and maintains cooperative relationships with community agencies and facilities.

Makes self available to department staff members to effect problem resolution as necessary.

Observes and respects HIPAA regulations and standards and reports violations to department leader.

FINANCIAL RESPONSIBILITY (Specify Revenue / Budget / Expense) : N / A

SUPERVISORY RESPONSIBILITIES

This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws.

Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning and directing work;

appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Screening Criteria usage

Demonstration of excellent clinical skills with ability to prioritize work effectively

Excellent interpersonal, negotiation and influence skills

Organized and adaptable; Change agent

Excellent verbal and written communication skills

Ability and comfort in working with physicians, allied health professionals, other members of the health care team, health plans, and patients / families

Knowledge of current regulatory environment as it pertains to effective Utilization / Case Management / Transition Management

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.

This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and / or any future required vaccines and screenings.

EDUCATION / LICENSURE / EXPERIENCE

Education :

Required : Diploma and / or AA Degree

Preferred : BSN preferred

License, Certification and / or Registration :

Required : Active Registered Nurse License

Preferred : ACM, CCM & CPUM preferred; other applicable certification

Experience :

Required : 3 5 years clinical nursing experience

Preferred Experience : Hospital Case Management experience

PHYSICAL DEMANDS

Must be able to work in sitting or standing position, use computer and answer telephone

Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

WORK ENVIRONMENT

Hospital Work Environment