Case Manager I Fulltime Days
Tenet Healthcare
- Sunnyvale, TX
- Permanent
- Full-time
- Modern Office Setting
- On-Site Cafe' and Coffee Bar (Payroll Deduction available)
- Collaborative Teams
- Team Member engagement opportunities
- Competitive pay
- Benefits provided based on your work assignment (Full-time, Part-time, or PRN)
- Responsible for performing assessments on Medicare, Medicaid, Private Pay, Commercial insured and high-risk patients to determine discharge planning needs, always documents assessments.
- Responsible for assessment of all aspects of patient care in an effort to optimize patient safety and reduces the likelihood of medical/health care errors.
- Able to communicate with physician regarding discharge planning needs of the patient. Assists the physician to facilitate post-hospital care.
- Is knowledgeable of criteria for Medicare, Medicaid, Commercial and private insurance coverage.
- Maintains current knowledge of resources available within the community, maintains supply of resource materials to be distributed to patients when needed. Is able to obtain other resources as needed.
- Communicates daily with admissions personnel regarding admissions and discharges to various units, when applicable.
- Initiates ongoing communication with the patient and patient's family to assess discharge needs.
- Treats patients and families with respect and dignity.
- Communicates with family members and caretakers regarding the needs of the patient and anticipated plans.
- Interacts professionally with patient/family and involves patient/family in the formation of the plan of care.
- Documents discharge planning in an ongoing manner.
- Is knowledgeable of patient's financial status, diagnosis and discharge needs.
- Is responsible for home care needs being met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known.
- Acts on performance improvement issues identified during CQI meetings.
- Cooperates with Case Manager's activities with insurance company, based on information received.
- Maintains and respects confidentiality of patient/physician/personnel information
- Collaborates with the Business Office Manager and onsite eligibility worker, where patients require such assistance.
- Accurately determines type of assistance/setting/resources necessary for the patient/family and provides appropriate resources/assistance list of facilities.
- Actively participates in Utilization Management Committee, CQI, varying team meetings and other meetings as appropriate.
- Demonstrates an ability to be flexible, organized and function under stressful situations.
- Maintains a good working relationship both within the department and with other departments.
- Consults other departments as appropriate to collaborate on patient care and performance improvement activities.
- Documentation meets current standards and policies.
- Current Registered Nurse licensure in State of Texas.
- Is a motivated, independent individual who can organize workload so that all functions are completed appropriately.
- Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage.
- Experience in providing patient care.
- Ability to read and communicate effectively in English.
- Additional languages preferred.
- Basic computer knowledge
a) accurate medical necessity screening and submission for Physician Advisor review,
b) care coordination,
c) transition planning assessment and reassessment,
d) implementation or oversight of implementation of the transition plan,
e) leading and facilitating multi-disciplinary patient care conferences,
f) managing concurrent disputes,
g) making appropriate referrals to other departments, h ) identifying and referring complex patients to Social Work Services,
I) communicating with patients and families about the plan of care,
j) collaborating with physicians, office staff and ancillary departments,
k) leading and facilitating Complex Case Review,
l) assuring patient education is completed to support post-acute needs ,
m) timely complete and concise documentation in Case Management system,
n) maintenance of accurate patient demographic and insurance information,
o) identification and documentation of potentially avoidable days,
p) identification and reporting over and underutilization,
q) and other duties as assigned.Qualifications: Education:Required: Graduate of an accredited school of nursing
Preferred: Academic degree in nursing (bachelor's or master's) Experience:Required: 2 years of acute hospital patient care experience
Preferred: Acute hospital case management experience Certifications:Required: 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: Accredited Case Manager (ACM) Physical Demands:Lift/position up to 25 lbs. Push/pull up to 25 lbs. of force. Frequent sitting. Moderate standing, walking, reaching, stooping, and bending. Manual dexterity, mobility, touch, auditory to perform all the related duties of the position.