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 patientï¿½s 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 individualï¿½s responsibilities include the following activities: ï¿½Accurate medical necessity screening and submission for Physician Advisor review, ï¿½Care coordination, ï¿½Transition planning assessment and reassessment, ï¿½Implementation or oversight of implementation of the transition plan, ï¿½Leading and facilitating multi-disciplinary patient care conferences, ï¿½Managing concurrent disputes, ï¿½Making appropriate referrals to other departments, h ) identifying and referring complex patients to Social Work Services, ï¿½Communicating with patients and families about the plan of care, ï¿½Collaborating with physicians, office staff and ancillary departments, ï¿½Leading and facilitating Complex Case Review, ï¿½Assuring patient education is completed to support post-acute needs , ï¿½Timely complete and concise documentation in Case Management system, n ) maintenance of accurate patient demographic and insurance information, ï¿½Identification and documentation of potentially avoidable days, ï¿½Identification and reporting over and underutilization, ï¿½And other duties as assigned
Preferred: Bachelor of Science in Nursing (BSN)
Required: Two (2) years acute hospital patient care experience. Preferred: Acute hospital case management experience.
Required: Active Registered Nurse license.
Job: Case Management/Home Health
Primary Location: Hialeah, Florida
Facility: Hialeah Hospital
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��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.
Internal Number: 1905035190
About Hialeah Hospital
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.