TRA Case Manager / Utilization Review Detroit Travel & Local

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.

This position will support all the facilities in the market as needed.

The individual’s 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, and

q) other duties as assigned.

Education :

Required : Graduate of an accredited school of nursing

Preferred : Academic degree in nursing (bachelor's or master's)

Experience :

Required : 2 years of acute hospital case management experience.

Preferred : Tenet hospital case management experience

Certifications :

Required : RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy.

Active RN license for state(s) covered.

Preferred : Accredited Case Manager (ACM)

Physical Demands :

Lift / position up to 25 lbs. Push / pull up to 25 lbs of force. Frequent sitting. Moderate standing, walking, reaching, stooping, and bending.

Manual dexterity, mobility, touch, auditory to perform all the related duties of the position.