The Case Manager is responsible for coordinating patient care activities to conform to evidence-based practice and/or regulatory/payor requirements.
The individuals responsibilities will include, but not be limited to the following activities: a) medical necessity screening b) care coordination c) discharge planning d) facilitating multi-disciplinary patient care conferences e) managing concurrent disputes f) making the appropriate referrals to other departments (e.g., nutrition, PT/OT/ST) g) referring complex social issues to Social Service h ) communicating with patients and their families about plan of care i) collaborating with physicians, office staff and ancillary departments (e.g., lab, pharmacy) j) participating in weekly Complex Case Review k) arranging for post discharge patient education l) clear, complete and concise documentation in eCCM m) maintaining accuracy of patient demographic and insurance informationn) identifying and documenting potentially avoidable days o) identifying and reporting over and under utilization.
Individual must possess the ability to:
The requirements listed below are representative of the knowledge, skill, and/or ability required. In accordance with The Americans with Disabilities Act (ADA), it is possible that requirements may be modified to reasonably accommodate disabled individuals. However, no accommodations will be made which may pose serious health or safety risks to the employee or others or which impose undue hardships on the organization.
Minimum Education: Associates in Nursing required. BSN preferred.
Minimum Experience: at least 3 to 5 years experience in the relevant clinical specialty (e.g., case manager for pediatrics patients should have pediatric nursing experience) b) excellent organizational skills c) excellent verbal and written communication skills; d) ability to lead and coordinate activities of a diverse group of people; e) demonstrated critical thinking and problem solving skills; and g) computer literate
Case Managers hired prior to August 2009 are grandfathered in with the same performance expectations.
Required Certifications/Registrations/Licenses: A valid Permanent Multi-State RN License from the state in which you reside is required. Should you hold a RN license from another Compact state, you are required to apply for and obtain a Multi-State RN License from the state in which you reside within 30 days. American Heart Association BLS CPR Required.
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.