RN Case Manager FT Days
Company: DMC Receiving Hospital
Posted on: February 7, 2024
DMC Detroit Receiving Hospital, Michigan's first Level I Trauma
Center, helped pioneer the evolution of emergency medicine and
currently has one of the busiest and most well-equipped emergency
departments anywhere. The first and largest verified burn center in
the state is at Receiving, and it is one of only 43 in the nation.
Receiving also offers the state's leading 24/7 hyperbaric oxygen
program, Metro Detroit's first certified primary stroke center, and
the nationally recognized and accredited DMC Rosa Parks Geriatric
Center of Excellence.
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
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
e) leading and facilitating multi-disciplinary patient care
f) managing concurrent disputes,
g) making appropriate referrals to other departments,
h ) identifying and referring complex patients to Social Work
i) communicating with patients and families about the plan of
j) collaborating with physicians, office staff and ancillary
k) leading and facilitating Complex Case Review,
l) assuring patient education is completed to support post-acute
m) timely complete and concise documentation in Case Management
n ) maintenance of accurate patient demographic and insurance
o) identification and documentation of potentially avoidable
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%
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,
1. Graduate from an accredited school of nursing. Bachelors 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
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.
Case Management/Home Health
DMC Receiving Hospital
2305002461Employment 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 Receiving Hospital, Detroit , RN Case Manager FT Days, Executive , Detroit, Michigan
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