RN Case Manager FT Days
Company: DMC Sinai-Grace Hospital
Location: Detroit
Posted on: April 25, 2024
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Job Description:
DMC Sinai-Grace Hospital is DMC's largest hospital, offering a
comprehensive heart center, cancer care, gerontology, emergency
medicine, obstetrics/gynecology and cosmetic services.
Sinai-Grace's joint replacement program features a revolutionary
minimally invasive knee and hip replacement surgery that attracts
patients from all over the country. Sinai-Grace operates more than
21 outpatient care sites and ambulatory surgery centers throughout
Wayne and Oakland Counties and is one of 10 hospitals in the nation
to be awarded a Robert Wood Johnson Foundation grant to help set
the standards of cardiac care for hospitals and physicians
throughout the nation.
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:
Minimum Qualifications
1. Required: High school diploma or equivalent
2. Required: 6 months phlebotomy experience or formal training,
Preferred: 1 year experience
Skills Required
1. Proficient in Phlebotomy techniques to include, venipuncture,
fingerstick, syringe draw, and butterfly draw methods used in
obtaining blood specimens.
2. Effective verbal and written communication skills to clearly
explain standard procedures and techniques, and to effectively
interact with customers, other health care providers and laboratory
personnel.
3. Physical ability and visual/manual dexterity to prepare and
carry out phlebotomy duties.
4. Creative thinking and problem-solving abilities.
Job:
Case Management/Home Health
Primary Location:
Detroit, Michigan
Facility:
DMC Sinai-Grace Hospital
Job Type:
Full Time
Shift Type:
Days
2406001245Employment 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 Sinai-Grace Hospital, Detroit , RN Case Manager FT Days, Executive , Detroit, Michigan
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