Job Description - RN Case Manager Women and Children Part Time Days (2406003239)
Description:
Children’s Hospital of Michigan is an international leader in pediatric and adolescent medicine. Surgical services include general, thoracic, reconstructive, and cardiovascular. Imaging technology designed specifically for children provides advanced diagnostic services including Positron Emission Tomography (PET) and MRI. The Children’s Hospital of Michigan Emergency Department is a verified Level 1 Pediatric Trauma Center and dedicated pediatric burn center. Experts in pediatric critical care, rehabilitation, and neonatal and perinatal medicine provide care for thousands of children every year.
Job Description:
The RN Case Manager is responsible for facilitating 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 patients' resources and right to self-determination. Responsibilities include:
- Accurate medical necessity screening and submission for Physician Advisor review.
- Care coordination.
- Transition planning assessment and reassessment.
- Implementation or oversight of the transition plan.
- Leading and facilitating multi-disciplinary patient care conferences.
- Managing concurrent disputes.
- Making appropriate referrals to other departments.
- Identifying and referring complex patients to Social Work Services.
- Communicating with patients and families about the plan of care.
- Collaborating with physicians, office staff, and ancillary departments.
- Leading and facilitating Complex Case Review.
- Assuring patient education is completed to support post-acute needs.
- Timely and concise documentation in the Case Management system.
- Maintenance of accurate patient demographic and insurance information.
- Identification and documentation of potentially avoidable days.
- Identification and reporting of over and underutilization.
- Other duties as assigned.
POSITION SPECIFIC RESPONSIBILITIES:
Utilization Management: Balances clinical and financial requirements in advocating for patient needs with judicious resource management. Assures the patient is in the appropriate status and level of care based on Medical Necessity process and submits cases for Secondary Physician review. Ensures timely communication of clinical data to payers to support admission, level of care, length of stay, and authorization for post-acute services.
Transition Management: Completes comprehensive assessment within 24 hours of patient admission to identify and document the anticipated transition plan for patients. Ensures all elements of the transition plan are communicated to the healthcare team, patient/family, and post-acute providers.
Care Coordination: Screens patients for factors that may affect the progression of care and intervenes as needed to promote timely and appropriate throughput.
Education: Ensures and provides education to patients, physicians, and the healthcare team relevant to effective progression of care and safe and timely patient transition.
Compliance: Ensures compliance with federal, state, and local regulations and accreditation requirements impacting case management scope of services.
Qualifications:
- 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.
- Two years of acute hospital patient care experience. Acute hospital case management experience preferred.
- License to practice as a Registered Nurse in the State of Michigan.
- Accredited Case Manager (ACM) preferred.
- Must complete Tenet's InterQual education course within 30 days of hire and pass with a score of 85 or better.
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.
Upon receipt of a conditional offer of employment, the applicant will be required to undergo a criminal background check.
Tenet participates in the E-Verify and Work Opportunity Tax Credit (WOTC) programs.
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