RN Case Manager Days FT
Company: DMC Children's Hospital of Michigan
Location: Detroit
Posted on: January 27, 2023
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Job 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.
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:
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.
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:
1. Graduate from an accredited school of nursing. Bachelor's degree
in Nursing or other health-related field, or equivalent combination
of education and/or related experience.
2. Two years of acute hospital patient care experience. Acute
hospital case management experience preferred.
3. License to practice as a Registered Nurse in the State of
Michigan.
4. Accredited Case Manager (ACM) preferred.
5. Must complete Tenets InterQual education course within 30 days
of hire (and at least annually thereafter) and pass with a score of
85 or better. Must complete and demonstrate competency in using the
Tenet Case Management documentation system within 30 days of hire.
Attendance at hospital and department orientation is required.
Department orientation includes review and instruction regarding
Tenet Case Management and Compliance policies, InterQual,
Transition Management, Utilization Management, and other topics
specific to case management.
Job:
Case Management/Home Health
Primary Location:
Detroit, Michigan
Facility:
DMC Children's Hospital of Michigan
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: DMC Children's Hospital of Michigan, Detroit , RN Case Manager Days FT, Executive , Detroit, Michigan
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