About this role
The RN Case Manager coordinates care along a continuum to support optimal health, access to care, and appropriate utilization of resources. The role focuses on utilization management, transition management, and care coordination to promote timely throughput and safe discharge while reducing avoidable readmissions.
Key Responsibilities
- Facilitate care along a continuum through effective resource coordination
- Conduct medical necessity screening and denial-prevention submissions for Physician Advisor review
- Manage transitions to promote appropriate length of stay, readmission prevention, and patient satisfaction
- Coordinate care sequence and level of care to improve throughput and support safe discharge
- Ensure compliance with state and federal regulatory requirements, TJC, and Tenet policy
Technical Overview
This role integrates national case management standards, including utilization management tied to medical necessity and denial prevention. It also emphasizes transition management for appropriate length of stay and safe discharge, while ensuring compliance with TJC accreditation standards and state and federal regulatory requirements.
Ideal Candidate
The ideal candidate is a Registered Nurse Case Manager experienced in utilization management and transition management. They can perform accurate medical necessity screening, coordinate resources across the care continuum, and support safe discharge while preventing avoidable readmissions and complying with TJC and regulatory requirements.
Must-Have Skills
facilitate care along a continuumeffective resource coordinationassess the patient for transition needsensure care is provided at the appropriate level of care based on medical necessityutilization management supporting medical necessity and denial preventiontransition management promoting appropriate length of stayreadmission prevention and patient satisfactioncare coordination demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of carecompliance with state and federal regulatory requirementsTJC accreditation standards and Tenet policy
Tools & Platforms
TJC accreditation standardsTenet policy
Required Skills
case managementutilization managementmedical necessity screeningdenial preventiontransition managementreadmission preventioncare coordinationthroughputsafe dischargecompliance with TJC accreditation standardsTenet policyeducation to physicians patients families caregivers
Hard Skills
care coordinationresource coordinationutilization managementmedical necessity screeningdenial preventiontransition managementreadmission preventionappropriate length of staysafe dischargeassessment for transition needspatient throughput efficiencyTJC accreditation standardsutilization reviewcase management scope of servicesCompliance with state and federal regulatory requirementsEducation provided to physicianspatientsfamilies and caregiversaccurate medical necessity screening and submission for Physician Advisor reviewcompliance with Tenet policymedical necessity submissionpatient self-determination
Soft Skills
communicationpatient-centered philosophycross-functional collaborationeducation to patients and familiescustomer service mindsetresource coordination and organization
Certifications
Required
Registered Nurse (RN)
Keywords for Your Resume
Registered Nurse Case ManagerRN Case ManagerRegistered Nursecase managementutilization managementmedical necessitydenial preventiontransition managementreadmission preventionpatient satisfactioncare coordinationthroughputsafe dischargeTJCTJC accreditation standardsPhysician Advisor reviewstate and federal regulatory requirementsTenet policyeducation provided to physicianspatientsfamilies and caregiverspatient self-determination
Deal Breakers
Must be a Registered Nurse (RN), Must be able to support utilization management, medical necessity screening, and denial prevention, Must be able to meet compliance expectations for TJC, state and federal regulatory requirements, and Tenet policy
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