Registered Nurse (RN) Case Manager

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.

• Accurate medical necessity screening and submission for Physician Advisor review
• Identifying and referring complex patients to Social Work Services
• Collaborating with physicians, office staff and ancillary departments
• Timely complete and concise documentation in Case Management system
• Identification and documentation of potentially avoidable days,
• Identification and reporting over and underutilization
• Performs related duties as required
• Required:
• Education: Graduate of an accredited school of nursing
• Experience: 2 years of acute hospital patient care experience
• Licensure/Certification:
• 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:
• Education: Academic degree in nursing (bachelor's or master's)
• Experience: Acute hospital case management experience
• Licensure/Certification: Accredited Case Manager (ACM)