Responsibilities:

DEPARTMENT SPECIFIC DUTIES:

Priority 1:  Coordination of 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. (40% daily, essential).

Priority 2: Identify and report variances in appropriateness of medical care provided, over/under utilization of resources compared to evidence-based practice and external requirements. This priority includes work with relevant software and communicating information through clear, complete and concise documentation in eCCM (40% daily, essential).

Priority 3:  Effective collaboration with physicians, nurses, ancillary staff, payors, patients and families to achieve optimum clinical outcomes (10% daily, essential).

Priority 4.  Remain current with relevant clinical/case management practices. (10% daily, essential).

The metrics below provide an indication of the effectiveness of the individual in this role and may be used for evaluative purposes.  The list below is not meant to be exhaustive; other relevant metrics may exist.

InterQual reviewsObservation hoursExcess Days/ALOSClinical disputes -  incidence and dollarsNumber and type of avoidable daysResource Utilization

At least 5 hours of CEUs per year on topics related to Case Management

Qualifications

POSITION QUALIFICATIONS:

Required:

Current California RN licenseMinimum 5 years bedside experience or in the relevant clinical specialty (e.g., case manager for pediatrics patients should have pediatric nursing experience)Excellent organizational skillsExcellent verbal and written communication skillsAbility to lead and coordinate activities of a diverse group of peopleDemonstrated critical thinking and problem solving skillsComputer literateCase Managers hired prior to August 2009 are grandfathered in with the same performance expectations.

Education:

Required: Graduate of an accredited school of nursing
Preferred: Academic degree in nursing (bachelor's or master's)

Preferred:

B.S.N. preferred

Experience:

Required: At least 1 year utilization review in an acute hospital or commercial/managed care payer setting. 
Preferred: Acute hospital case management experience

Certifications:

Required: RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered.
Preferred: Accredited Case Manager (ACM)

PHYSICAL REQUIREMENTS:

While performing the duties of this job, the employee is regularly required to sit, talk, and hear.  The employee is frequently required to use fine motor skill (typing/data entry), and reach with hands and arms. The employee is frequently required to stand; walk; and occasionally stoop, kneel, or crawl.  The employee must regularly lift and /or move up to 20 pounds and occasionally lift and/or move up to 50 pounds. Individual works in a clinical and office environment.

Shift: Days

Hours: 8:00am - 4:30pm

Schedule: Rotating weekends. 

#LI-DH1

Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law. 

Description

Desert Regional Medical Center is a 385-bed acute-care hospital classified as a stroke receiving center and level 2 trauma facility with an innovative, patient centered and evidence-based Rehabilitation Services Department. Our compassionate team provides a wide range of inpatient and outpatient services, including acute care rehabilitation, joint replacement & spinal surgery, neurosurgery, ICU, Telemetry, step-down care, skilled nursing, as well as outpatient therapy, hand and lymphedema clinics.

GENERAL DUTIES:

The individual in this position has overall responsibility for overseeing the clinical plan of care to conform to evidence-based practice and regulatory requirements. This position integrates care coordination, utilization management, and discharge planning.

The individual’s responsibilities will include, but not be limited to the following activities:

Medical necessity screeningCare coordinationDischarge planning Facilitating multi-disciplinary patient care conferencesManaging concurrent disputesMaking the appropriate referrals to other departments (e.g., nutrition, PT/OT/ST)Referring complex social issues to Social ServiceCommunicating with patients and their families about the plan of careCollaborating with physicians, office staff and ancillary departments (e.g., lab, pharmacy) Participating in weekly Complex Case ReviewArranging for post –discharge patient education Clear, complete and concise documentation in eCCMMaintaining accuracy of patient demographic and insurance information Identifying and documenting potentially avoidable daysIdentifying and reporting over and underutilizationAnd other duties as assigned.

Attends hospital workshop led by the Director of Case Management or designee that includes the Tenet Case Management Model, InterQual, Discharge Planning, Utilization Management, and other topics specific to case management. Extended orientation with selected Case Managers may occur.

Information used to perform job: patient data, healthcare staff documentation related to patient care, regulatory and payor requirements

Software used to perform job: eCCM: Clinical data interface, InterQual, Case Management documentation, secure faxing, Avoidable Day tracking, Patient Medical Record and HPF, Hospital specific Clinical Software

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