Registered Nurse (RN) - Case Management

Registered Nurse (RN) - Case Management

Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients' lives while enjoying a supportive work environment that fosters professional growth and work-life balance. Ready to be a vital part of our mission? Apply today and bring your passion for nursing to a place where it truly matters!

The individual in this position is responsible to facilitate 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 provided is at the appropriate level of care based on medical necessity. This position manages the medical necessity process for accurate and timely payment for services that may require negotiation with a payor on a case-by-case basis.

This position integrates national standards for case management scope of services including:

• Utilization Management services supporting medical necessity and denial prevention
• Coordinating with payors to authorize appropriate level of care and length of stay for medically necessary services required for the patient
• Collaborating with Care Coordination by demonstrating efficient throughput while assuring care is sequenced and at the appropriate level of care
• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
• Educating payors, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits and compliance

The individual's responsibilities include the following activities:

• Securing and documenting authorization for services from payors
• Performing accurate medical necessity screening and timely submission for Physician Advisor reviews
• Collaborating with payors, physicians, office staff and ancillary departments
• Managing concurrent disputes
• Identification and reporting over and under utilization
• Timely, complete, and concise documentation in Tenet Case Management documentation system
• Maintenance of accurate patient demographic and insurance information
• Identification and documentation of potentially avoidable days

POSITION SPECIFIC RESPONSIBILITIES:

• Utilization Management
• Payor Authorization
• Education
• Compliance

Minimum Qualifications:

BSN preferred. At least two (2) years acute hospital or Behavioral Health patient care experience required. One (1) year hospital acute or behavioral health case management experience preferred. Active and valid RN license required. Accredited Case Manager (ACM) preferred.

Skills Required:

Analytical ability, critical thinking, problem solving skills and comprehensive knowledge base to identify opportunities for improvement and problem resolution, evaluate patient status and health care procedures/techniques, and monitor quality of patient care. Knowledge of care delivery capabilities along the continuum of care. Interpersonal skills to work productively with all levels of hospital personnel. Resourcefulness to identify prompt and sustainable solutions to barriers in care delivery.

Verbal and written communication skills to communicate effectively with diverse populations including physicians, colleagues, patients, and families. Teaching abilities to conduct educational programs for staff. Flexibility with schedule, including off-shifts, weekends, and holidays in order to meet the needs of patients, families or staff. Organizational skills and ability to lead and coordinate activities of a diverse group of people in a fast-paced environment, and direct others toward objectives that contribute to the success of the department.

Ability to cope with stressful situations, manage multiple and sometimes conflicting priorities simultaneously. Computer literacy to utilize case management systems.

Job:
Case Management/Home Health

Primary

Location:

MI-Detroit

Hospital/Facility:
Detroit Medical Center Shared Services Job Type : PT2Y Shift Type :
Days