Staff - Registered Nurse (RN) - Case Manager, Clinical Support Specialist -$31-44 per hour

Staff - Registered Nurse (RN) - Case Manager, Clinical Support Specialist - $31-44 per hour at Baptist Health System - San Antonio TX summary :

The Registered Nurse (RN) Case Manager coordinates patient care to ensure optimal health outcomes, appropriate resource utilization, and safe transitions within the healthcare continuum. This role involves medical necessity screening, care coordination, transition planning, patient and family education, and compliance with regulatory standards. The position supports preventing avoidable readmissions and promoting timely patient throughput through collaboration with multidisciplinary teams.

Baptist Health System - San Antonio TX is seeking a Registered Nurse (RN) Case Manager, Clinical Support Specialist for a nursing job in Harlingen, Texas.

Job Description & Requirements

• Specialty : Clinical Support Specialist
• Discipline : RN
• Duration : Ongoing
• 36 hours per week
• Shift : 12 hours
• Employment Type : Staff

This position may qualify for a sign-on bonus

Summary

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 patient’s 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 individual’s responsibilities include the following activities : 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.

Baptist Health System - San Antonio Job ID #. Posted job title : Registered Nurse Case Manager Full Time Days

Benefits

Keywords :

Registered Nurse, Case Manager, Care Coordination, Utilization Management, Transition Planning, Patient Education, Healthcare Compliance, Medical Necessity, Readmission Prevention, Clinical Support