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RN Case Manager FT Days

Company: Doctors Medical Center of Modesto
Location: Modesto
Posted on: January 11, 2019

Job Description:

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

Responsibilities

The individual's responsibilities include the following activities: Accurate medical necessity screening and submission for Physician Advisor review,
Care coordination,
Transition planning assessment and reassessment,
Implementation or oversight of implementation of the transition plan,
Leading and facilitating multi-disciplinary patient care conferences,
Managing concurrent disputes,
Making appropriate referrals to other departments, h ) identifying and referring complex patients to Social Work Services,
Communicating with patients and families about the plan of care,
Collaborating with physicians, office staff and ancillary departments,
Leading and facilitating Complex Case Review,
Assuring patient education is completed to support post-acute needs ,
Timely complete and concise documentation in Case Management system, n ) maintenance of accurate patient demographic and insurance information,
Identification and documentation of potentially avoidable days,
Identification and reporting over and underutilization,
And other duties as assigned



Qualifications:
CA RN license
2+ years current adult care experience required.
Must have job shadowed in the Case Management Department within the past 6 months.

Job: Case Management/Home Health
Primary Location: Modesto, California
Facility: Doctors Medical Center of Modesto
Job Type: Full-time
Shift Type: Days

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.

Keywords: Doctors Medical Center of Modesto, Modesto , RN Case Manager FT Days, Healthcare , Modesto, California

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