Registered Nurse (RN) - Case Manager

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!

Benefit Statement

At Tenet Healthcare, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include :

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off (PTO)
• Career development and continuing education opportunities
• Health savings accounts, healthcare C dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder C childcare, auto C home insurance.

Note : Eligibility for benefits may vary by location and is determined by employment status

Job Description

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 patients 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 Individuals Responsibilities Include The Following Activities

h ) identifying and referring complex patients to Social Work Services,

n ) maintenance of accurate patient demographic and insurance information,

Position Specific Responsibilities

Utilization Management : Balances clinical and financial requirements and resources 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 case for Secondary Physician review per Tenet policy. Ensures timely communication of clinical data to payers to support admission, level of care, length of stay and authorization for post-acute services . Advocates for the patient and hospital with payers to secure appropriate payment for services rendered. Promotes prudent utilization of all resources (fiscal, human, environmental, equipment and services) by evaluating resources available to the patient and balancing cost and quality to assure optimal clinical and financial outcomes. Identifies and documents Avoidable Days using the data to address opportunities for improvement. Prevents denials and disputes by communicating with payers and documenting relevant information. Coordinates clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post- acute care) compared to evidence-based practice, internal and external requirements. (30% daily, essential).

Transition Management : Completes comprehensive assessment within 24 hours of patient admission to identify and document the anticipated transition plan for patients. Integrates key elements of patient assessment, patient choice and available resources to develop and implement a successful transition plan. Identifies patients at risk for readmission and applies appropriate intervention including risk assessment and referral to Social Work services and / or Complex Case Review. May delegate the implementation of the transition plan to LVN / LPN or Assistant staff. And follows up to ensure the transition plan is completed timely and accurately. Ensures all elements of the transition plan are implemented and communicated to the healthcare team, patient / family and post-acute providers. Provides information to patients to make informed choices when community services per Tenet policy. Completes Final Discharge Disposition Form Assessment for Medicare patients per Tenet policy. Identifies and reports variances in appropriateness of medical care provided, over / under utilization of resources compared to evidence-based practice and external requirements. This priority includes documentation in the Tenet Case Management system to communicating information through clear, complete and concise documentation (30% daily, essential).

Care Coordination : Screens patients for factors that may affect the progression of care and intervenes as needed to promote timely and appropriate throughput. Conducts assessments and stratifies patients at risk for readmission or in need of Case Management services. Ensures the plan of care is clinically appropriate, consistent with patient choice and available resources. Ensures consults, testing and procedures are sequenced to support the patients clinical needs with timely and efficient care delivery. Ensures patient needs are communicated and that the healthcare team is mutually accountable to achieve the patient plan of care. Effectively collaborates with physicians, nurses, ancillary staff, payors, patients and families to achieve optimum clinical outcomes (15% daily, essential).

Education : Ensures and provides education to patients, physicians and the healthcare team relevant to the- Effective progression of care, Appropriate level of care, and Safe and timely patient transition. Provides patient and healthcare team education regarding resources and benefits available to the patient along with the economic impact of care options. Ensures that education has been provided to the patient / family / caregiver by the healthcare team prior to discharge (15% daily, essential).

Compliance : Ensures compliance with federal, state, and local regulations and accreditation requirements impacting case management scope of services. Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies. Operates within the LVN / LPN scope of practice as defined by state licensing regulations. Remains current with Tenet Case Management practices (10% daily, essential).

Qualifications

Vaccination Statement

Tenet Healthcare / TPR complies with federal, state, and / or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular

testing in accordance with the law.

Facility 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 at Children’s Hospital of Michigan, Children’s Hospital of Michigan - Troy and six ambulatory sites.

EEO Statement

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.

Tenet participates in the E-Verify program. Follow the link below for additional information.

E-Verify : Job : Case Management / Home Health

Primary Location : Detroit, Michigan

Facility : DMC Children's Hospital of Michigan

Job Type : Part Time

Shift Type : Day

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.