RN Case Manager-CONTINGENT
RN Case Manager-CONTINGENT
Job Location Name
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
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, q) and other duties as assigned.
1. Graduate from an accredited school of nursing. Bachelor s 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 Tenet s 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.
Nursing - Licensed
At Detroit Medical Center (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, national origin, age, protected veteran status or status as an individual disability.